title: Rehabilitation services following total joint replacement: a qualitative analysis of key processes and structures to decrease length of stay and increase surgical volumes in Ontario, Canada.
abstract: OBJECTIVE
  The purpose of this study was: (1) to identify key total joint replacement (TJR) care processes and structures from acute care and rehabilitation hospitals; (2) to determine the perceived implications of practice patterns and processes on wait times, discharge planning, transitions in care, utilization of rehabilitation services, and outcomes; and (3) to understand how acute care hospitals funded for additional cases were addressing current and future rehabilitation needs.
  
  
  METHODS
  A qualitative descriptive approach using key informant interviews was used to provide further insights and depth of understanding to current practice patterns, structures and processes of care for TJR patients.
  
  
  RESULTS
  Twenty-three key informants from a total of 15 hospitals across Ontario participated in this project. Themes that emerged related to processes of care (e.g. patient education, preoperative services, clinical pathways), and structures that supported these processes of care (e.g. organizational supports, increased funding and resources). The results point to a number of key practices that can facilitate smooth, integrated care for TJR patients, particularly in relation to best practices to decrease length of stay and increase surgical volumes. Increased funding related to strategic priorities placed on TJRs by the provincial government was viewed as an important impetus to implement a number of these key practices.
  
  
  CONCLUSIONS
  From a rehabilitation perspective, there is need for consistent funding to secure more rehabilitation services for both preoperative and post-operative management of care that allows for shorter lengths of stay and to ensure optimal outcomes.
authors.affiliation: Toronto Rehabilitation Institute and Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Carol
authors.initials: C
authors.lastname: Fancott
authors.forename: Susan
authors.initials: S
authors.lastname: Jaglal
authors.forename: Victoria
authors.initials: V
authors.lastname: Quan
authors.forename: Katherine
authors.initials: K
authors.lastname: Berg
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Cott
authors.forename: Aileen
authors.initials: A
authors.lastname: Davis
authors.forename: John
authors.initials: J
authors.lastname: Flannery
authors.forename: Gillian
authors.initials: G
authors.lastname: Hawker
authors.forename: Michel D
authors.initials: MD
authors.lastname: Landry
authors.forename: Nizar N
authors.initials: NN
authors.lastname: Mahomed
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Badley
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D019091:Critical Pathways; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D007902:Length of Stay; D009864:Ontario; D011300:Preoperative Care; D019145:Rehabilitation Nursing / Q000458:organization & administration*