Predictors of Length of Stay, Discharge Disposition, and Hospital Charges in Elders Following Hip and Knee Arthroplasty

2.50
Hdl Handle:
http://hdl.handle.net/10755/154698
Type:
Presentation
Title:
Predictors of Length of Stay, Discharge Disposition, and Hospital Charges in Elders Following Hip and Knee Arthroplasty
Abstract:
Predictors of Length of Stay, Discharge Disposition, and Hospital Charges in Elders Following Hip and Knee Arthroplasty
Conference Sponsor:Sigma Theta Tau International
Conference Year:2002
Conference Date:July, 2002
Author:Epps, Cynthia
P.I. Institution Name:State University of West Georgia
Title:Assistant Professor
OBJECTIVE: To identify differences in patient, clinical, and treatment factors in patients discharged home compared to those discharged to subacute facilities following hip and knee arthroplasty and to determine the relationship of these factors to length of stay, discharge disposition, and hospital charges. DESIGN: A predictive retrospective design was used for this study. POPULATION, SAMPLE, SETTING, YEARS: Data was collected from the medical records of 166 patients over the age of 60 who underwent total hip or knee arthroplasty in a rural hospital between November 1, 1999, and July 15, 2001. VARIABLES: Independent variables included patient factors (age, gender, race, living arrangement), clinical factors (total lymphocyte count, hematocrit, comorbidities, body mass index), and treatment factors (anesthesia type, surgical time, postoperative analgesia, number of analgesia doses in the first 48 hours postoperatively, number of postoperative complications). Outcome variables included length of stay, discharge disposition, and hospital charges. METHODS: Descriptive statistics, multiple regression, and logistic regression were used. FINDINGS: Data analyses indicated that patients discharged from the hospital to another care facility were likely to be older women who lived alone. Married women were more likely than married men to be discharged to another healthcare facility, as were those with more comorbidities and more postoperative complications. Gender and age increased length of stay and hospital charges, postoperative complications contributed to extended lengths of stay, and both time in surgery and postoperative complications contributed to higher hospital charges. CONCLUSIONS: The results of this investigation provide an indication of the variables associated with good and poor outcomes based on patient and clinical (individual) factors, and treatment (process) factors. Knowledge of their effects provides valuable information for the planning of patient services. Patients who are women, who are older, who live alone, and those who are in poorer overall health likely require more rehabilitation than that received in acute care facilities. Patients who have longer surgical times and an increased number of postoperative complications can be expected to have lengthier hospital stays and higher hospital charges. Clinical pathways and practice guidelines cannot be formulated without objective data that identifies which patient, clinical, and treatment factors most influence outcomes. IMPLICATIONS: Outcome information is necessary to bridge the gap between interventions (what is done) and outcomes (what is accomplished). Determination of the consequences of healthcare through outcomes research provides a foundation for evidence-based nursing practice that will improve the health, function, and well-being of older people undergoing hip or knee arthroplasty. Findings from this study can be used to design and test practice guidelines and clinical pathways for hip or knee arthroplasty patients so that quality of care is enhanced and costs are contained. Although research about factors that might correlate or predict length of stay, discharge disposition, and hospital charges has proliferated, definitive identification of individual and process variables that account for variance in outcomes has not occurred. Findings from this study have added to the evidence base of nursing practice related to arthroplasty patients and has been useful for determining what still needs to be studied. Extending this research to involve other patient and treatment factors such as spiritual and satisfaction variables or practitioner skill levels will provide more evidence upon which cost-effective, quality nursing care can be based.

Repository Posting Date:
26-Oct-2011
Date of Publication:
Jul-2002
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titlePredictors of Length of Stay, Discharge Disposition, and Hospital Charges in Elders Following Hip and Knee Arthroplastyen_GB
dc.identifier.urihttp://hdl.handle.net/10755/154698-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Predictors of Length of Stay, Discharge Disposition, and Hospital Charges in Elders Following Hip and Knee Arthroplasty</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2002</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">July, 2002</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Epps, Cynthia</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">State University of West Georgia</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">cepps@westga.edu</td></tr><tr><td colspan="2" class="item-abstract">OBJECTIVE: To identify differences in patient, clinical, and treatment factors in patients discharged home compared to those discharged to subacute facilities following hip and knee arthroplasty and to determine the relationship of these factors to length of stay, discharge disposition, and hospital charges. DESIGN: A predictive retrospective design was used for this study. POPULATION, SAMPLE, SETTING, YEARS: Data was collected from the medical records of 166 patients over the age of 60 who underwent total hip or knee arthroplasty in a rural hospital between November 1, 1999, and July 15, 2001. VARIABLES: Independent variables included patient factors (age, gender, race, living arrangement), clinical factors (total lymphocyte count, hematocrit, comorbidities, body mass index), and treatment factors (anesthesia type, surgical time, postoperative analgesia, number of analgesia doses in the first 48 hours postoperatively, number of postoperative complications). Outcome variables included length of stay, discharge disposition, and hospital charges. METHODS: Descriptive statistics, multiple regression, and logistic regression were used. FINDINGS: Data analyses indicated that patients discharged from the hospital to another care facility were likely to be older women who lived alone. Married women were more likely than married men to be discharged to another healthcare facility, as were those with more comorbidities and more postoperative complications. Gender and age increased length of stay and hospital charges, postoperative complications contributed to extended lengths of stay, and both time in surgery and postoperative complications contributed to higher hospital charges. CONCLUSIONS: The results of this investigation provide an indication of the variables associated with good and poor outcomes based on patient and clinical (individual) factors, and treatment (process) factors. Knowledge of their effects provides valuable information for the planning of patient services. Patients who are women, who are older, who live alone, and those who are in poorer overall health likely require more rehabilitation than that received in acute care facilities. Patients who have longer surgical times and an increased number of postoperative complications can be expected to have lengthier hospital stays and higher hospital charges. Clinical pathways and practice guidelines cannot be formulated without objective data that identifies which patient, clinical, and treatment factors most influence outcomes. IMPLICATIONS: Outcome information is necessary to bridge the gap between interventions (what is done) and outcomes (what is accomplished). Determination of the consequences of healthcare through outcomes research provides a foundation for evidence-based nursing practice that will improve the health, function, and well-being of older people undergoing hip or knee arthroplasty. Findings from this study can be used to design and test practice guidelines and clinical pathways for hip or knee arthroplasty patients so that quality of care is enhanced and costs are contained. Although research about factors that might correlate or predict length of stay, discharge disposition, and hospital charges has proliferated, definitive identification of individual and process variables that account for variance in outcomes has not occurred. Findings from this study have added to the evidence base of nursing practice related to arthroplasty patients and has been useful for determining what still needs to be studied. Extending this research to involve other patient and treatment factors such as spiritual and satisfaction variables or practitioner skill levels will provide more evidence upon which cost-effective, quality nursing care can be based.<br/><br/></td></tr></table>en_GB
dc.date.available2011-10-26T13:12:23Z-
dc.date.issued2002-07en_GB
dc.date.accessioned2011-10-26T13:12:23Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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