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Predictors of inpatient rehabilitation after total knee replacement: an analysis of private hospital claims data
Author(s) -
Schilling Chris,
Keating Catherine,
Barker Anna,
Wilson Stephen F,
Petrie Dennis
Publication year - 2018
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja17.01231
Subject(s) - rehabilitation , medicine , acute care , inpatient care , retrospective cohort study , emergency medicine , multivariate analysis , confidence interval , physical therapy , health care , surgery , economics , economic growth
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.