title: Hospital-Based Acute Care After Total Hip and Knee Arthroplasty: Implications for Quality Measurement.
abstract: BACKGROUND
  Although hospital readmissions are being adopted as a quality measure after total hip or knee arthroplasty, they may fail accurately capture the patient's postdischarge experience.
  
  
  METHODS
  We studied 272,853 discharges from 517 hospitals to determine hospital emergency department (ED) visit and readmission rates.
  
  
  RESULTS
  The hospital-level, 30-day, risk-standardized ED visit (median = 5.6% [2.4%-13.7%]) and hospital readmission (5.0% [2.6%-9.2%]) rates were similar and varied widely. A hospital's risk-standardized ED visit rate did not correlate with its readmission rate (r = -0.03, P = .50). If ED visits were included in a broader "readmission" measure, 246 (47.6%) hospitals would change perceived performance groups.
  
  
  CONCLUSIONS
  Including ED visits in a broader, hospital-based, acute care measure may be warranted to better describe postdischarge health care utilization.
authors.affiliation: Department of Orthopaedic Surgery, Sports Medicine, and Rehabilitation, Boonshoft School of Medicine, Wright State University, Dayton, Ohio.
authors.forename: Roman
authors.initials: R
authors.lastname: Trimba
authors.affiliation: Department of Orthopaedic Surgery, Sports Medicine, and Rehabilitation, Boonshoft School of Medicine, Wright State University, Dayton, Ohio; Department of Orthopaedic Surgery, Dayton Veteran's Association Medical Center, Dayton, Ohio.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Laughlin
authors.affiliation: Department of Orthopaedic Surgery, Dayton Veteran's Association Medical Center, Dayton, Ohio.
authors.forename: Anil
authors.initials: A
authors.lastname: Krishnamurthy
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
authors.affiliation: Department of Surgery, Boonshoft School of Medicine, Wright State University, Dayton, Ohio.
authors.forename: Justin P
authors.initials: JP
authors.lastname: Fox
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods* / Q000592:standards; D019645:Arthroplasty, Replacement, Knee / Q000379:methods* / Q000592:standards; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D010359:Patient Readmission; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D019467:Subacute Care / Q000379:methods* / Q000592:standards
keywords: emergency department visits; hospital readmission; quality measurement; total hip arthroplasty; total knee arthroplasty