title: Comparison of two home care protocols for total joint replacement.
abstract: 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.
authors.affiliation: 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
authors.forename: Frances M
authors.initials: FM
authors.lastname: Weaver
authors.forename: Susan L
authors.initials: SL
authors.lastname: Hughes
authors.forename: Orit
authors.initials: O
authors.lastname: Almagor
authors.forename: Richard
authors.initials: R
authors.lastname: Wixson
authors.forename: Larry
authors.initials: L
authors.lastname: Manheim
authors.forename: Bradley
authors.initials: B
authors.lastname: Fulton
authors.forename: Ruth
authors.initials: R
authors.lastname: Singer
mesh_terms: 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