title: Data Sharing Between Providers and Quality Initiatives Eliminate Unnecessary Nursing Home Admissions.
abstract: The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) has monitored discharge disposition, after total hip and knee arthroplasties, since inception in 2012 and found the standardized risk of extended care facility (ECF) placement to be highly variable between hospitals.
  
  
  
  The variation in standardized risks of ECF placement among MARCQI member sites was reported to the collaborative. At the May 2, 2014 quarterly meeting, a quality initiative was started, emphasizing the wide variability between hospitals, the contribution of hospital and surgeon to that variability using median odds ratios, and the need for outlier hospitals to initiate quality improvement (QI) processes. Patients from 29 hospitals that were members of MARCQI before the intervention were included in this analysis. We compared standardized risks before and after the intervention in the entire cohort, and for 3 hospitals that implemented institution-specific QI projects. We report changes in ECF placement, length of stay, emergency room visits, and readmissions over time.
  
  
  
  This study includes 31,347 patients before and 20,879 patients after the implementation of the quality initiative. The range in standardized risk dropped from 9.4%-46.1% to 9.4%-32.4% and the average dropped from 23.0% to 19.6%. Three outlier hospitals decreased their absolute risk of ECF placement by 12.2%, 8.9%, and 12.4% after QI, without increases in adverse outcomes.
  
  
  
  Discharge to ECF after primary hip and knee arthroplasties is highly variable and influenced by hospital and surgeon practices. Hospital-level QI measures can decrease ECF admissions.
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan Medical Center, Ann Arbor, Michigan.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Charles
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan Medical Center, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan Medical Center, Ann Arbor, Michigan; Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) Coordinating Center, University of Michigan Medical Center, Ann Arbor, Michigan.
authors.forename: Bonita M
authors.initials: BM
authors.lastname: Singal
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan Medical Center, Ann Arbor, Michigan.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Urquhart
authors.affiliation: Department of Orthopaedic Surgery, Saint Joseph Mercy Hospital, Ann Arbor, Michigan.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Masini
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan Medical Center, Ann Arbor, Michigan.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Hallstrom
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008824:Michigan; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D016017:Odds Ratio; D010343:Patient Admission; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission; D058996:Quality Improvement; D011787:Quality of Health Care; D012042:Registries; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*
keywords: extended care facility; hip arthroplasty; knee arthroplasty; nursing home; quality improvement; skilled nursing facility