A Risk Assessment Tool Based on Orthopedic Psychosocial and Health Status Factors is Associated With Post-Acute Resources

We implemented a risk assessment tool (RAT) used by clinical navigators to quantify pre-operative mobility, home safety, social/cognitive barriers, and patient health history. We sought to determine if this RAT is associated with the need for post-acute care (PAC) services defined as inpatient rehabilitation and skilled nursing facility, home health, and none (home) following total joint arthroplasty.

The study sample comprised of a total of 1438 primary TJA patients included in a bundled payment model. The RAT score, which ranges from 0 to 100, with higher scores representing healthier, more independent patents, was the key independent variable and post-acute service was the primary outcome variable.

The median RAT score was 83 (interquartile range 78-87.5) for no PAC discharges compared to 74 (interquartile range 67-81) for inpatient PAC discharges ( P < .0001). After adjusting for the effects of length of hospital stay, surgery type, and patient gender, there was 6× increased odds of inpatient PAC for higher risk patients compared to low risk patients. A RAT score of 74 predicts discharges without PAC 87% of the time.

The RAT that is based on psychosocial, cognitive, environmental factors, and health status was significantly associated with the need for PAC services. The next step is to build and validate a real time, risk adjustment model to assist physicians and patients with planning post-discharge resources.