Measure Information Form

Measure Set: Total Hip and Total Knee Replacement Inpatient (THKR-IP)

Set Measure ID: THKR-IP-3

Set Measure ID	Performance Measure Name
THKR-IP-3a	Discharged to Home- Hip and Knee Overall
THKR-IP-3b	Discharged to Home - Hip
THKR-IP-3c	Discharged to Home - Knee

Performance Measure Name: Discharged to Home

Description: Patients discharged to home following total hip or total knee replacement.

Rationale: Home-based rehabilitation is increasingly utilized to reduce health-care costs; however, with a shorter hospital stay, the possibility arises for an increase in adverse clinical outcomes. Research has shown that despite concerns about early hospital discharge, there is no difference in pain, functional outcomes, or patient satisfaction between groups that received home-based rehabilitation versus inpatient rehabilitation. Home-based rehabilitation protocol following elective primary total hip or knee replacement is the more cost-effective strategy.^1-2

According to 2012 Medicare claims data, 49% of patients undergoing hip and knee replacements were discharged to an inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF) for rehabilitation. Therefore, only 51% of patients were discharged to home.

Type Of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Patients who were discharged to home following total hip or total knee replacement.

Included Populations: Patients discharged to home with or without home health services, in-home physical therapy or outpatient physical therapy.
Excluded Populations: None
Data Elements:

Discharge Disposition

Denominator Statement: Patients undergoing a total hip or total knee replacement.

Included Populations:

Patients with an ICD-10-PCS Principal Procedure Code as defined in Appendix A: Table 14.01a Total Hip Replacement or Table 14.02a Total Knee Replacements

Excluded Populations:

Patients less than 18 years of age

Patients who have a Length of Stay greater than 120 days

Residents of Other Health Care Facility:

Extended or Intermediate Care Facility (ECF/ICF)

Long Term Acute Care Hospital (LTACH)

Nursing Home or Facility including Veteran’s Administration Nursing Facility

Psychiatric Hospital or Psychiatric Unit of a Hospital

Skilled Nursing Facility (SNF), Sub-Acute Care or Swing Bed

Veterans Home

Patients with an ICD-10-PCS Other Procedure Code as defined in Appendix A: Table 14.01a (concurrent total hip replacements), or Table 14.02a (concurrent total knee replacements), or Table 14.05a (partial hip and partial knee replacements), or Table 14.06a (revision and resurfacing procedures), or Table 14.07a (removal of implanted devices/prostheses)

Patients with an ICD-10-CM Principal Diagnosis Code or ICD-10-CM Other Diagnosis Code as defined in Appendix A: Table 14.08 (complication of internal fixation device/prosthesis), Table 14.09 (malignant neoplasm of the pelvis, sacrum, coccyx, lower limbs, or bone/bone marrow or a disseminated malignant neoplasm), or Table 14.10 (femur, hip, pelvic fracture)

Patient expired

Patient left AMA

Physician/APN/PA/nurse/social worker/care manager/discharge planner/physical therapist/occupational therapist documentation of medical/social reason why patient cannot be discharged to home.

Data Elements:

Admission Date

Birthdate

Discharge Date

Discharge Disposition

ICD-10-CM Other Diagnosis Codes

ICD-10-CM Principal Diagnosis Code

ICD-10-PCS Other Procedure Codes

ICD-10-PCS Principal Procedure Code

Reason for Not Discharging Patient to Home

Resident of Other Health Care Facility

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Some hospitals may prefer to gather data concurrently by identifying patients in the population of interest. This approach provides opportunities for improvement at the point of care/service. However, complete documentation includes the principal or other ICD-10 diagnosis and procedure codes, which require retrospective data entry.

Data Accuracy: Variation may exist in the assignment of ICD-10 codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: None

Sampling: Yes. Please refer to the measure set specific sampling requirements and for additional information see the Population and Sampling Specifications Section.

Data Reported As: Aggregate rate generated from count data reported as a proportion. Proportion for hip replacements, proportion for knee replacements and aggregated proportion for hip & knee replacements.

Selected References:

¹Mahomed NN, Davis AM, Hawker G, Badley E, Davey JR, Syed KA. et al. Inpatient compared with home-based rehabilitation following primary unilateral total hip or knee replacement: a randomized controlled trial. J Bone Joint Surg Am. 2008;90(8):1673–1680.
²Padgett DE, et al. Study: Patients Who Go Home After Knee Replacement Do As Well as Those Discharged to Rehab Facility. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2015; Las Vegas.
Inpatient Rehabilitation Facility Services: Assessing payment adequacy and updating payments - Report to the Congress: Medicare Payment Policy March 2014
Mallinson TR, Bateman J, Tseng HY, Manheim L, et al. A Comparison of Discharge Functional Status After Rehabilitation in Skilled Nursing, Home Health, and Medical Rehabilitation Settings for Patients After Lower-Extremity Joint Replacement Surgery. Arch Phys Med Rehabil Vol 92, May 2011.
Fleischman A, Austin, M, Purtill JJ, Parvizi J, Hozack WJ, The Rothman Institute Study: Even if you live alone, there is no place like home after total joint arthroplasty. Presented at American Academy of Orthopaedic Surgeons Annual Meeting; March 14, 2017; San Diego, CA.
McLawhorn AS, Fu, MC, Schairer WW, Sculco PK, MacLeanCH,Padgett DE. Continued Inpatient Care After Primary Total Knee Arthroplasty Increases 30-Day Post-Discharge Complications: A Propensity Score-Adjusted Analysis. The Journal of Arthroplasty. January 31, 2017 (http://dx.doi.org/10.1016/j.arth.2017.01.039).
Ramos NL, Karia RJ, Hutzler LH, Brandt AM, Slover JD, Bosco JA. The effect of discharge disposition on 30-day readmission rates after total joint arthroplasty. J Arthroplasty. 2014 Apr;29(4):674-7. doi: 10.1016/j.arth.2013.09.010. Epub 2013 Oct 30.

Measure Algorithm:

Specifications Manual for Joint Commission National Quality Measures (v2020A2)
Discharges 01-01-20 (1Q20) through 6-30-20 (2Q20)

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