Outpatient,Home-Based Physical Therapy Promotes Decreased Length of Stay and Post-Acute Resource Utilization After Total Joint Arthroplasty

BackgroundPatients and healthcare systems are increasingly focused on evaluating interventions that increase the value of care delivered. Our objective of this study is to evaluate early post-operative outcomes among those patients who underwent total joint arthroplasty with and without the participation in our piloted Outpatient Physical Therapy Home Visits (OPTHV) program.MethodsA retrospective analysis of patients undergoing total hip arthroplasty and total knee arthroplasty at a single institution from July 2016 to September 2017 was performed. Matched cohorts were compared according to OPTHV enrollment status.ResultsIn total, 1729 patients were included in this study. Two hundred ninety-three patients were enrolled in OPTHV, while 1436 patients received institutional standard care. Patients were matched by gender (56.7% vs 57.7% female, P = .751), age (67.75 vs 66.95 years, P = .167), body mass index (30.18 vs 30.12 kg/m², P = .859), and average American Society of Anesthesiologists score (2.31 vs 2.36, P = .131). OPTHV patients had a shorter length of stay (1.39 vs 1.64 days, P < .001) and were more likely to discharge to home (89.8% vs 74.7%, P < .001). Ninety-day re-admissions (2.7% vs 2.6%, P = .880) and emergency room visits (4.1% vs 4.3%, P = .864) were equivalent.ConclusionOPTHV is a novel program that facilitates discharge home and decreased length of stay after total joint arthroplasty without increasing re-admissions or emergency room visits. Utilization of OPTHV may contribute toward reducing the episode of care costs by reducing utilization of skilled nursing facility and home health services. Further prospective studies are needed to evaluate the effect of OPTHV on the total cost of care and functional outcomes.     

Evaluating quality in clinical care

Defining and maintaining quality is essential to surgical practice. It is only through structured approaches to assessing outcomes that we can ensure that optimal care is delivered. This article will define quality in healthcare and discuss assessment models with reference to pertinent surgical literature. National initiatives are discussed with a critical appraisal of their role and effectiveness. We discuss the aim of quality improvement initiatives and comment on reporting of outcomes. The difficult question of how to maintain quality during a crisis, such as an infectious disease pandemic, is addressed.     

The relationship between perceived organisational threat and compassion for others: Implications for the NHS

The National Health Service (NHS) is known to be a challenging place to work, with financial and performance targets placing increasing pressure on the organisation. This study aimed to investigate whether these pressures and threats might be detrimental to the quality of care and the compassion that the NHS strives to deliver. Quantitative data were collected via self‐report questionnaires from healthcare professionals across 3 NHS trusts in England in order to measure Self‐compassion; Compassion for Others; Perceived Organisational Threat; and Perceived Organisational Compassion. Qualitative data were also collected to explore the threats considered most pertinent to healthcare professionals at present. The key findings suggest that an increase in Perceived Organisational Threat may reduce an individual's ability to give compassion to others; however, Self‐compassion and Perceived Organisational Compassion were better predictors of Compassion for Others. This highlights the need to consider compassion at a systemic level, providing interventions and training not only to cultivate self‐compassion in healthcare professionals, but also to encourage compassion across the NHS more generally. In promoting self‐compassion and increasing the level of compassion that employees feel they receive at work, healthcare professionals may be better able to maintain or improve their level of compassion for service users and colleagues.     

Contingent engagement: What we learn from patients with complex health problems and low socioeconomic status

Objective

Elicit patients’ perceptions of factors that facilitate their engagement in care

Development and evaluation of the Communication over Language Barriers questionnaire (CoLB-q) in paediatric healthcare

Objective

To develop a valid and reliable questionnaire addressing the experiences of healthcare personnel of communicating over language barriers and using interpreters in paediatric healthcare.

Measuring patient-provider communication skills in Rwanda: Selection,adaptation and assessment of psychometric properties of the Communication Assessment Tool

Objective

To identify, adapt and validate a measure for providers’ communication and interpersonal skills in Rwanda.

Interprofessional practice in healthcare: Experiences of a faculty learning community

Healthcare reform has had its impact on many health professionals as well as clinical settings, particularly with the enactment of the Affordable Care Act. In healthcare settings, healthcare teams are challenged with new systems of care and changing philosophies of management. However, healthcare providers retain a distinctive sense that they cannot always provide care without some form of collaboration. This article presents the results of a pilot study, which measured the effectiveness of a model of practice utilised at a faculty-practitioner operated university community clinic. The purpose of the study was to measure the perceived effectiveness of a practice model, client satisfaction, and students’ perceptions of learning. Implications of this pilot study include providing an interprofessional practice model, which can be replicated in any healthcare setting. This study also provides an opportunity to improve student learning in degree programmes where practice is a significant aspect of the learning process.