Comparison of two home care protocols for total joint replacement.
OBJECTIVE
To examine the effect of a more-efficient home care protocol to manage total joint replacement (TJR) patients after surgery.


METHODS
A randomized trial of two home care protocols for TJR management.


METHODS
A hospital-affiliated home healthcare agency in a large midwestern city.


METHODS
Medicare-eligible individuals undergoing elective total hip or knee replacement surgery (N = 136).


METHODS
A home care protocol that included preoperative home visits by a nurse and a physical therapist and fewer postoperative visits (range of 9-12 visits) to the home than an existing protocol (range of 11-47 visits).


METHODS
Functional status, lower extremity functioning, health-related quality of life, satisfaction with care, and use and cost of healthcare services for 6 months postsurgery.


RESULTS
There were no differences in functional status, health-related quality of life, or lower extremity functioning by group at 6 months. A marginally significant gain in satisfaction with access to care (P =.059) was found in the intervention group at 6 months. Home healthcare costs were 55% lower for the streamlined group (P <.001). Other costs did not differ significantly by group.


CONCLUSIONS
TJR patients who received the more-efficient home care protocol experienced comparable outcomes to those who received the existing protocol. An abbreviated set of home care visits resulted in more-efficient delivery of care without compromising patient outcomes.
Weaver
Frances M
FM
Midwest Center for Health Services and Policy Research, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois 60141, USA. weaver@research.hines.med.va.gov
Hughes
Susan L
SL
Almagor
Orit
O
Wixson
Richard
R
Manheim
Larry
L
Fulton
Bradley
B
Singer
Ruth
R
D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D015577:Geriatric Assessment; D018575:Home Care Services, Hospital-Based / Q000458:organization & administration*; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011182:Postoperative Care; D011788:Quality of Life