title: Changes in Payment Regulation and Acute Care Use for Total Hip Replacement: Trends in Length of Stay, Costs, and Discharge, 1997-2012.
abstract: OBJECTIVE
  To describe trends in the length of stay (LOS), costs, mortality, and discharge destination among a national sample of total hip replacement (THR) patients between 1997 and 2012.
  
  
  METHODS
  Longitudinal retrospective design
  
  
  METHODS
  Descriptive analysis of the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample data.
  
  
  RESULTS
  A total of 3,516,636 procedures were performed over the study period. Most THR patients were women, and the proportion aged 44-65 years increased. LOS decreased from 5 to 3 days. Charges more than doubled, from $22,184 to $53,901. Deaths decreased from 43 to 12 deaths per 10,000 patients. THR patients discharged to an institutional setting declined, while those discharged to the community increased.
  
  
  CONCLUSIONS
  We found an increase in THR patients, who were younger, women, had private insurance, and among those discharged to community-based settings.
  
  
  CONCLUSIONS
  Findings have implications for patient profiles, workplace environments, quality improvement, and educational preparation of nurses in acute and postacute settings.
authors.affiliation: Duke University, School of Nursing, Durham, NC, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Cary
authors.affiliation: Virginia Commonwealth University, School of Nursing, Richmond, VA, USA.
authors.forename: Marianne
authors.initials: M
authors.lastname: Baernholdt
authors.affiliation: Duke University, School of Nursing, Durham, NC, USA.
authors.forename: Elizabeth I
authors.initials: EI
authors.lastname: Merwin
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics* / Q000639:trends*; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data; D004509:Education, Nursing, Continuing; D005260:Female; D005544:Forecasting; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics* / Q000639:trends; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000191:economics* / Q000639:trends*; D019145:Rehabilitation Nursing / Q000191:economics* / Q000639:trends*; D012189:Retrospective Studies
keywords: Utilization; outcomes; quality improvement; total hip replacement
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