Post-Acute Care Trends and Disparities After Joint Replacements in the United States, 1991-2018: A Systematic Review.
Bridget Morse-Karzen, Ji Won Lee, Patricia W Stone and 5 others
PMID 39009064WHAT IT FOUND
After joint replacement in the US, skilled nursing facility or nursing home discharges decreased in four studies and increased in one, but Black patients were more likely than White patients to go to institutional care and less likely to go home without home health care.
Key findings
01Discharge to skilled nursing facilities or nursing homes decreased over time in four studies, increased in one study, and home discharge increased except in one study.
02White individuals were more likely than Black individuals to be discharged home without home health care in five studies.
03Black individuals were more often discharged to skilled nursing facilities or nursing homes in 12 studies and to inpatient rehabilitation facilities in 10 studies.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The review included 17 studies, and 16 used cross-sectional designs. Only one study directly examined urban versus rural differences, and rural access to post-acute care may limit comparisons. Race, ethnicity, and post-acute care categories were defined differently across studies. Many studies combined knee and hip replacement, so differences by joint type are unclear. The review could not control for all contextual factors or examine how they interact. The review was limited to US studies, so it may not apply to other countries.
Declared interests
All authors declared no conflicts of interest.
The easy way to misread this
Do not read the decline in skilled nursing facility or nursing home discharges as evidence that most patients now go home without home health care. The decline was not uniform, and Black patients were still more likely than White patients to be discharged to institutional post-acute care.