Abstract
Objective: To investigate inpatient rehabilitation rates after private total knee replacements (TKRs) in Australia since 2009; to quantify the contributions of hospital-, surgeon-and patient-related factors to predicting inpatient rehabilitation. Design: Retrospective cohort study; multivariate linear regression analysis of linked, de-identified Medibank administrative claims data and hospital casemix protocol data, adjusted for patient-related characteristics. Setting, participants: 35 389 patients undergoing Medibank-funded TKRs in 170 private hospitals in Australia, 2009−2016. Main outcome measures: Hospital inpatient rehabilitation rate; relative contributions of patient-and provider-related characteristics to variation in inpatient rehabilitation rates. Results: The overall inpatient rehabilitation rate increased from 31% in 2009 to 45% in 2016, but varied between hospitals (range, 0−100%). The reduction in mean acute length of stay during this period explained about 15% of this increase, and about 30% was explained by patient-related factors; more than half of the increase was explained by neither reduced length of stay or patient-related factors. Patient-related characteristics explained little of the variation in rates between hospitals. Rates at 27% of hospitals lay above the 95% confidence limit for the mean inpatient rehabilitation rate in private hospitals (38%), both before and after adjusting for patient-related factors. Provider characteristics explained three times as much of the variation as patient characteristics (75% v 25%); hospital-related factors made the largest contribution to variation (47%). Conclusion: Inpatient rehabilitation after TKR has increased in private health care during the past 8 years. Substantial variation in inpatient rehabilitation rates is not explained by patient-related factors, suggesting that some inpatient rehabilitation is low value care.
| Original language | English |
|---|---|
| Pages (from-to) | 222-227 |
| Number of pages | 6 |
| Journal | Medical Journal of Australia |
| Volume | 209 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - 3 Sep 2018 |
Cite this
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Predictors of inpatient rehabilitation after total knee replacement : an analysis of private hospital claims data. / Schilling, Chris; Keating, Catherine; Barker, Anna; Wilson, Stephen F.; Petrie, Dennis.
In: Medical Journal of Australia, Vol. 209, No. 5, 03.09.2018, p. 222-227.Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Predictors of inpatient rehabilitation after total knee replacement
T2 - an analysis of private hospital claims data
AU - Schilling, Chris
AU - Keating, Catherine
AU - Barker, Anna
AU - Wilson, Stephen F.
AU - Petrie, Dennis
PY - 2018/9/3
Y1 - 2018/9/3
N2 - Objective: To investigate inpatient rehabilitation rates after private total knee replacements (TKRs) in Australia since 2009; to quantify the contributions of hospital-, surgeon-and patient-related factors to predicting inpatient rehabilitation. Design: Retrospective cohort study; multivariate linear regression analysis of linked, de-identified Medibank administrative claims data and hospital casemix protocol data, adjusted for patient-related characteristics. Setting, participants: 35 389 patients undergoing Medibank-funded TKRs in 170 private hospitals in Australia, 2009−2016. Main outcome measures: Hospital inpatient rehabilitation rate; relative contributions of patient-and provider-related characteristics to variation in inpatient rehabilitation rates. Results: The overall inpatient rehabilitation rate increased from 31% in 2009 to 45% in 2016, but varied between hospitals (range, 0−100%). The reduction in mean acute length of stay during this period explained about 15% of this increase, and about 30% was explained by patient-related factors; more than half of the increase was explained by neither reduced length of stay or patient-related factors. Patient-related characteristics explained little of the variation in rates between hospitals. Rates at 27% of hospitals lay above the 95% confidence limit for the mean inpatient rehabilitation rate in private hospitals (38%), both before and after adjusting for patient-related factors. Provider characteristics explained three times as much of the variation as patient characteristics (75% v 25%); hospital-related factors made the largest contribution to variation (47%). Conclusion: Inpatient rehabilitation after TKR has increased in private health care during the past 8 years. Substantial variation in inpatient rehabilitation rates is not explained by patient-related factors, suggesting that some inpatient rehabilitation is low value care.
AB - Objective: To investigate inpatient rehabilitation rates after private total knee replacements (TKRs) in Australia since 2009; to quantify the contributions of hospital-, surgeon-and patient-related factors to predicting inpatient rehabilitation. Design: Retrospective cohort study; multivariate linear regression analysis of linked, de-identified Medibank administrative claims data and hospital casemix protocol data, adjusted for patient-related characteristics. Setting, participants: 35 389 patients undergoing Medibank-funded TKRs in 170 private hospitals in Australia, 2009−2016. Main outcome measures: Hospital inpatient rehabilitation rate; relative contributions of patient-and provider-related characteristics to variation in inpatient rehabilitation rates. Results: The overall inpatient rehabilitation rate increased from 31% in 2009 to 45% in 2016, but varied between hospitals (range, 0−100%). The reduction in mean acute length of stay during this period explained about 15% of this increase, and about 30% was explained by patient-related factors; more than half of the increase was explained by neither reduced length of stay or patient-related factors. Patient-related characteristics explained little of the variation in rates between hospitals. Rates at 27% of hospitals lay above the 95% confidence limit for the mean inpatient rehabilitation rate in private hospitals (38%), both before and after adjusting for patient-related factors. Provider characteristics explained three times as much of the variation as patient characteristics (75% v 25%); hospital-related factors made the largest contribution to variation (47%). Conclusion: Inpatient rehabilitation after TKR has increased in private health care during the past 8 years. Substantial variation in inpatient rehabilitation rates is not explained by patient-related factors, suggesting that some inpatient rehabilitation is low value care.
UR - http://www.scopus.com/inward/record.url?scp=85053380781&partnerID=8YFLogxK
U2 - 10.5694/mja17.01231
DO - 10.5694/mja17.01231
M3 - Article
VL - 209
SP - 222
EP - 227
JO - Medical Journal of Australia
JF - Medical Journal of Australia
SN - 0025-729X
IS - 5
ER -