It’s no secret that affluence can affect the level of healthcare services an individual receives. And, according to a recent analysis, the community in which a patient lives influences whether he or she will receive postoperative care and rehabilitation after elective hip replacement surgery in a facility or at home.
That conclusion was drawn through the analysis of a large regional database performed by researchers from Hospital for Special Surgery and Weill Cornell Medicine.

Those researchers likewise concluded that patients in the least affluent communities were more likely to be discharged to an inpatient rehabilitation or skilled nursing facility rather than home care after hip replacement.

Joint replacement explosion

“With the aging of the population, elective total hip replacement has become one of the fastest-growing procedures to manage severe osteoarthritis,” says Bella Mehta, MBBS, MS, a rheumatologist at Hospital for Special Surgery (HSS) in New York City, who presented the findings recently at the American College of Rheumatology/Association of Rheumatology Professionals annual meeting.

“Medicare, the largest payor of joint replacement surgery, has introduced several payment reform models that target discharge destination and risk of hospital readmission after surgery,” Mehta notes in a media release. “Our study examined how the socioeconomic status of the community in which one resides influences discharge destination and the odds of 90-day hospital readmission after hip replacement.”

Location, location, location

Mehta points out that where a patient receives postop care and rehab has a considerable impact on the total cost of hip replacement surgery. Previous studies have demonstrated significant variations in outcomes and costs due to individual factors such as race. There have been far fewer studies on the impact of community-level factors.

“Our study pushes the envelope by examining the role of where one lives in understanding variations in post-op care after elective joint replacement surgery. And it reflects the growing academic collaboration in clinical research between HSS and Weill Cornell Medicine investigators,” Said Ibrahim MD, MPH, MBA, senior investigator and chief of the Division of Healthcare Delivery Science and Innovation at Weill Cornell Medicine, explains.

For the analysis, the investigators identified almost 85,000 patients in the Pennsylvania Health Care Cost Containment Council database who had elective hip replacement surgery between 2012 and 2016. The researchers used the Area Deprivation Index (ADI) from the American Census Survey, which reflects a geographic area’s level of socioeconomic deprivation and is associated with health outcomes.

Poor people discharge to an institution

The study found that patients from impoverished communities were more likely to be discharged to an institution compared to home after a hip replacement. The interaction effect of race and ADI on discharge destination was statistically significant in African American patients 65 years and older, but not in patients under 65 years old.

As a possible explanation for the study findings, Mehta notes that patients from impoverished communities may have less access to community-based services such as social support. Thus, discharge to a facility for postoperative and rehabilitative care might be perceived as a safer option in clinical decision-making.

Mehta adds, “The ultimate goal of research is to design socially informed health policies to improve quality of care and outcomes.”

[Source(s): Hospital for Special Surgery, PR Newswire]