title: Patient report improves posthospital discharge event capture in total joint replacement: a novel approach to capturing all posthospital event data.
abstract: BACKGROUND
  Current approaches to quantifying total posthospital complications and readmissions following surgical procedures are limited because the United States does not have a single health care payer. Patients seek posthospital care in varied locations, yet hospitals can only quantify those returning to the same facility. Seeking information directly from patients about health care utilization following hospital discharge holds promise to provide data that is missing for surgeons and health care systems.
  
  
  BACKGROUND
  Because total joint replacement (TJR) is the most common and costly elective surgical hospitalization, we examined the concordance between patients' self-report of potential short-term complications and their readmissions and our review of medical records in the initial hospital and surrounding facilities.
  
  
  METHODS
  Patients undergoing primary total hip or knee replacement from July 1, 2011, through December 3, 2012, at a large site participating in a national cohort of TJR patients were identified. Patients completed a six-month postoperative survey regarding emergency department (ED), day surgery (DS), or inpatient care for possible medical or mechanical post-TJR complications. We reviewed inpatient and outpatient medical records from all regional facilities and examined the sensitivity, specificity, and positive- and negative predictive values for patient self-report and medical records.
  
  
  RESULTS
  There were 413 patients who had 431 surgeries and completed the six-month questionnaire. Patients reported 40 medical encounters (9 percent) including ED, DS or inpatient care, of which 20 percent occurred at hospitals different from the initial surgery. Review of medical records revealed 9 additional medical encounters that patients had not mentioned including five hospitalizations following surgery and four ED visits. Overall patient self-report of ED, DS, and inpatient care for possible complications was both sensitive (82 percent) and specific (100 percent). The positive predictive value was 100 percent and negative predictive value 98 percent.
  
  
  CONCLUSIONS
  Patient self-report of posthospital events was accurate. Substantial numbers of patients required care at outlying hospitals (not where the TJR occurred).
  
  
  CONCLUSIONS
  Methods that directly engage patients can augment current posthospital utilization surveillance to assure complete data.
authors.affiliation: University of Massachusetts Medical School.
authors.forename: Leslie
authors.initials: L
authors.lastname: Harrold
authors.affiliation: University of Massachusetts Medical School.
authors.forename: Scott
authors.initials: S
authors.lastname: Pascal
authors.affiliation: Hartford Hospital.
authors.forename: Courtland
authors.initials: C
authors.lastname: Lewis
authors.affiliation: University of Rochester School of Medicine.
authors.forename: Regis
authors.initials: R
authors.lastname: O'Keefe
authors.affiliation: Medical University of South Carolina.
authors.forename: Vincent
authors.initials: V
authors.lastname: Pellegrini
authors.affiliation: University of Massachusetts Medical School.
authors.forename: Jeroan
authors.initials: J
authors.lastname: Allison
authors.affiliation: University of Massachusetts Medical School.
authors.forename: David
authors.initials: D
authors.lastname: Ayers
authors.affiliation: University of Massachusetts Medical School.
authors.forename: Patricia
authors.initials: P
authors.lastname: Franklin
keywords: adverse events; complications; patient self-report; readmissions; total joint replacement
references.citation: Clin Orthop Relat Res. 2002 Sep;(402):164-70
references.pmid: 12218480
references.citation: J Arthroplasty. 2010 Sep;25(6 Suppl):21-5
references.pmid: 20541885
references.citation: J Bone Joint Surg Am. 1997 Apr;79(4):485-94
references.pmid: 9111392
references.citation: Am J Orthop (Belle Mead NJ). 2010 Sep;39(9 Suppl):22-8
references.pmid: 21290028
references.citation: J Bone Joint Surg Am. 2007 Mar;89(3):526-33
references.pmid: 17332101
references.citation: J Arthroplasty. 2010 Sep;25(6 Suppl):58-61
references.pmid: 20570479
references.citation: J Bone Joint Surg Am. 1982 Dec;64(9):1295-306
references.pmid: 7142237
references.citation: J Bone Joint Surg Am. 2003 Jan;85-A(1):20-6
references.pmid: 12533567
references.citation: JAMA. 2012 Sep 26;308(12):1217-8
references.pmid: 23011710
references.citation: J Arthroplasty. 2012 Aug;27(7):1310-5
references.pmid: 22197286
references.citation: J Bone Joint Surg Am. 2007 Aug;89(8):1675-84
references.pmid: 17671004
references.citation: Am J Med Qual. 2009 Sep-Oct;24(5):395-402
references.pmid: 19584374
references.citation: J Bone Joint Surg Am. 2003 Jan;85-A(1):27-32
references.pmid: 12533568
references.citation: J Clin Epidemiol. 2004 Sep;57(9):985-8
references.pmid: 15504642
references.citation: J Arthroplasty. 2009 Sep;24(6 Suppl):105-9
references.pmid: 19493644
references.citation: J Bone Joint Surg Am. 2001 Nov;83-A(11):1622-9
references.pmid: 11701783
references.citation: J Arthroplasty. 2008 Sep;23(6 Suppl 1):139-45
references.pmid: 18722311
references.citation: J Clin Epidemiol. 2007 Nov;60(11):1190-4
references.pmid: 17938062
references.citation: Orthop Clin North Am. 1999 Apr;30(2):183-90
references.pmid: 10196420
references.citation: Arthritis Care Res (Hoboken). 2010 May;62(5):719-24
references.pmid: 20191473