Effects of Postacute Settings on Readmission Rates and Reasons for Readmission Following Total Knee Arthroplasty.

Only Medicare fee-for-service beneficiaries aged 66 years and older were studied, so it does not apply to younger patients or those in managed care. The analysis used claims data, which can have coding errors, and it did not examine specific comorbidities, functional status or quality of care. Community discharge combined patients going home with and without home health and did not capture outpatient rehabilitation, so home discharge was not one uniform level of support. The study did not distinguish potentially preventable from non-preventable unplanned readmissions. Patients discharged to SNF or IRF were older and had more comorbidities, more prior stays and longer hospital stays, so the setting association may reflect patient need rather than harm from the setting.

Do not conclude that skilled nursing or inpatient rehabilitation causes more readmissions, or that every knee replacement patient should be discharged home. Patients sent to those settings were older and had more comorbidities and longer stays, and this claims analysis cannot separate the effect of the setting from the patient's need for that setting.