Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS hospital records from 1997 to 2014

Publication Date:
2018-01-28
Publisher:
BMJ Publishing
Electronic ISSN:
2044-6055
Topics:
Medicine
Keywords:
Open access, Health services research
Published by:
http://group.bmj.com/
_version_ 1836398765987069952
autor Burn, E., Edwards, C. J., Murray, D. W., Silman, A., Cooper, C., Arden, N. K., Pinedo-Villanueva, R., Prieto-Alhambra, D.
beschreibung Objectives To measure changes in length of stay following total knee and hip replacement (TKR and THR) between 1997 and 2014 and estimate the impact on hospital reimbursement, all else being equal. Further, to assess the degree to which observed trends can be explained by improved efficiency or changes in patient profiles. Design Cross-sectional study using routinely collected data. Setting National Health Service primary care records from 1995 to 2014 in the Clinical Practice Research Datalink were linked to hospital inpatient data from 1997 to 2014 in Hospital Episode Statistics Admitted Patient Care. Participants Study participants had a diagnosis of osteoarthritis or rheumatoid arthritis. Interventions Primary TKR, primary THR, revision TKR and revision THR. Primary outcome measures Length of stay and hospital reimbursement. Results 10 260 primary TKR, 10 961 primary THR, 505 revision TKR and 633 revision THR were included. Expected length of stay fell from 16.0 days (95% CI 14.9 to 17.2) in 1997 to 5.4 (5.2 to 5.6) in 2014 for primary TKR and from 14.4 (13.7 to 15.0) to 5.6 (5.4 to 5.8) for primary THR, leading to savings of £1537 and £1412, respectively. Length of stay fell from 29.8 (17.5 to 50.5) to 11.0 (8.3 to 14.6) for revision TKR and from 18.3 (11.6 to 28.9) to 12.5 (9.3 to 16.8) for revision THR, but no significant reduction in reimbursement was estimated. The estimated effect of year of surgery remained similar when patient characteristics were included. Conclusions Length of stay for joint replacement fell substantially from 1997 to 2014. These reductions have translated into substantial savings. While patient characteristics affect length of stay and reimbursement, patient profiles have remained broadly stable over time. The observed reductions appear to be mostly explained by improved efficiency.
citation_standardnr 6148017
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feed_publisher BMJ Publishing
feed_publisher_url http://group.bmj.com/
insertion_date 2018-01-28
journaleissn 2044-6055
publikationsjahr_anzeige 2018
publikationsjahr_facette 2018
publikationsjahr_intervall 7984:2015-2019
publikationsjahr_sort 2018
publisher BMJ Publishing
quelle BMJ Open
relation http://bmjopen.bmj.com/cgi/content/short/8/1/e019146?rss=1
schlagwort Open access, Health services research
search_space articles
shingle_author_1 Burn, E., Edwards, C. J., Murray, D. W., Silman, A., Cooper, C., Arden, N. K., Pinedo-Villanueva, R., Prieto-Alhambra, D.
shingle_author_2 Burn, E., Edwards, C. J., Murray, D. W., Silman, A., Cooper, C., Arden, N. K., Pinedo-Villanueva, R., Prieto-Alhambra, D.
shingle_author_3 Burn, E., Edwards, C. J., Murray, D. W., Silman, A., Cooper, C., Arden, N. K., Pinedo-Villanueva, R., Prieto-Alhambra, D.
shingle_author_4 Burn, E., Edwards, C. J., Murray, D. W., Silman, A., Cooper, C., Arden, N. K., Pinedo-Villanueva, R., Prieto-Alhambra, D.
shingle_catch_all_1 Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS hospital records from 1997 to 2014
Open access, Health services research
Objectives To measure changes in length of stay following total knee and hip replacement (TKR and THR) between 1997 and 2014 and estimate the impact on hospital reimbursement, all else being equal. Further, to assess the degree to which observed trends can be explained by improved efficiency or changes in patient profiles. Design Cross-sectional study using routinely collected data. Setting National Health Service primary care records from 1995 to 2014 in the Clinical Practice Research Datalink were linked to hospital inpatient data from 1997 to 2014 in Hospital Episode Statistics Admitted Patient Care. Participants Study participants had a diagnosis of osteoarthritis or rheumatoid arthritis. Interventions Primary TKR, primary THR, revision TKR and revision THR. Primary outcome measures Length of stay and hospital reimbursement. Results 10 260 primary TKR, 10 961 primary THR, 505 revision TKR and 633 revision THR were included. Expected length of stay fell from 16.0 days (95% CI 14.9 to 17.2) in 1997 to 5.4 (5.2 to 5.6) in 2014 for primary TKR and from 14.4 (13.7 to 15.0) to 5.6 (5.4 to 5.8) for primary THR, leading to savings of £1537 and £1412, respectively. Length of stay fell from 29.8 (17.5 to 50.5) to 11.0 (8.3 to 14.6) for revision TKR and from 18.3 (11.6 to 28.9) to 12.5 (9.3 to 16.8) for revision THR, but no significant reduction in reimbursement was estimated. The estimated effect of year of surgery remained similar when patient characteristics were included. Conclusions Length of stay for joint replacement fell substantially from 1997 to 2014. These reductions have translated into substantial savings. While patient characteristics affect length of stay and reimbursement, patient profiles have remained broadly stable over time. The observed reductions appear to be mostly explained by improved efficiency.
Burn, E., Edwards, C. J., Murray, D. W., Silman, A., Cooper, C., Arden, N. K., Pinedo-Villanueva, R., Prieto-Alhambra, D.
BMJ Publishing
2044-6055
20446055
shingle_catch_all_2 Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS hospital records from 1997 to 2014
Open access, Health services research
Objectives To measure changes in length of stay following total knee and hip replacement (TKR and THR) between 1997 and 2014 and estimate the impact on hospital reimbursement, all else being equal. Further, to assess the degree to which observed trends can be explained by improved efficiency or changes in patient profiles. Design Cross-sectional study using routinely collected data. Setting National Health Service primary care records from 1995 to 2014 in the Clinical Practice Research Datalink were linked to hospital inpatient data from 1997 to 2014 in Hospital Episode Statistics Admitted Patient Care. Participants Study participants had a diagnosis of osteoarthritis or rheumatoid arthritis. Interventions Primary TKR, primary THR, revision TKR and revision THR. Primary outcome measures Length of stay and hospital reimbursement. Results 10 260 primary TKR, 10 961 primary THR, 505 revision TKR and 633 revision THR were included. Expected length of stay fell from 16.0 days (95% CI 14.9 to 17.2) in 1997 to 5.4 (5.2 to 5.6) in 2014 for primary TKR and from 14.4 (13.7 to 15.0) to 5.6 (5.4 to 5.8) for primary THR, leading to savings of £1537 and £1412, respectively. Length of stay fell from 29.8 (17.5 to 50.5) to 11.0 (8.3 to 14.6) for revision TKR and from 18.3 (11.6 to 28.9) to 12.5 (9.3 to 16.8) for revision THR, but no significant reduction in reimbursement was estimated. The estimated effect of year of surgery remained similar when patient characteristics were included. Conclusions Length of stay for joint replacement fell substantially from 1997 to 2014. These reductions have translated into substantial savings. While patient characteristics affect length of stay and reimbursement, patient profiles have remained broadly stable over time. The observed reductions appear to be mostly explained by improved efficiency.
Burn, E., Edwards, C. J., Murray, D. W., Silman, A., Cooper, C., Arden, N. K., Pinedo-Villanueva, R., Prieto-Alhambra, D.
BMJ Publishing
2044-6055
20446055
shingle_catch_all_3 Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS hospital records from 1997 to 2014
Open access, Health services research
Objectives To measure changes in length of stay following total knee and hip replacement (TKR and THR) between 1997 and 2014 and estimate the impact on hospital reimbursement, all else being equal. Further, to assess the degree to which observed trends can be explained by improved efficiency or changes in patient profiles. Design Cross-sectional study using routinely collected data. Setting National Health Service primary care records from 1995 to 2014 in the Clinical Practice Research Datalink were linked to hospital inpatient data from 1997 to 2014 in Hospital Episode Statistics Admitted Patient Care. Participants Study participants had a diagnosis of osteoarthritis or rheumatoid arthritis. Interventions Primary TKR, primary THR, revision TKR and revision THR. Primary outcome measures Length of stay and hospital reimbursement. Results 10 260 primary TKR, 10 961 primary THR, 505 revision TKR and 633 revision THR were included. Expected length of stay fell from 16.0 days (95% CI 14.9 to 17.2) in 1997 to 5.4 (5.2 to 5.6) in 2014 for primary TKR and from 14.4 (13.7 to 15.0) to 5.6 (5.4 to 5.8) for primary THR, leading to savings of £1537 and £1412, respectively. Length of stay fell from 29.8 (17.5 to 50.5) to 11.0 (8.3 to 14.6) for revision TKR and from 18.3 (11.6 to 28.9) to 12.5 (9.3 to 16.8) for revision THR, but no significant reduction in reimbursement was estimated. The estimated effect of year of surgery remained similar when patient characteristics were included. Conclusions Length of stay for joint replacement fell substantially from 1997 to 2014. These reductions have translated into substantial savings. While patient characteristics affect length of stay and reimbursement, patient profiles have remained broadly stable over time. The observed reductions appear to be mostly explained by improved efficiency.
Burn, E., Edwards, C. J., Murray, D. W., Silman, A., Cooper, C., Arden, N. K., Pinedo-Villanueva, R., Prieto-Alhambra, D.
BMJ Publishing
2044-6055
20446055
shingle_catch_all_4 Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS hospital records from 1997 to 2014
Open access, Health services research
Objectives To measure changes in length of stay following total knee and hip replacement (TKR and THR) between 1997 and 2014 and estimate the impact on hospital reimbursement, all else being equal. Further, to assess the degree to which observed trends can be explained by improved efficiency or changes in patient profiles. Design Cross-sectional study using routinely collected data. Setting National Health Service primary care records from 1995 to 2014 in the Clinical Practice Research Datalink were linked to hospital inpatient data from 1997 to 2014 in Hospital Episode Statistics Admitted Patient Care. Participants Study participants had a diagnosis of osteoarthritis or rheumatoid arthritis. Interventions Primary TKR, primary THR, revision TKR and revision THR. Primary outcome measures Length of stay and hospital reimbursement. Results 10 260 primary TKR, 10 961 primary THR, 505 revision TKR and 633 revision THR were included. Expected length of stay fell from 16.0 days (95% CI 14.9 to 17.2) in 1997 to 5.4 (5.2 to 5.6) in 2014 for primary TKR and from 14.4 (13.7 to 15.0) to 5.6 (5.4 to 5.8) for primary THR, leading to savings of £1537 and £1412, respectively. Length of stay fell from 29.8 (17.5 to 50.5) to 11.0 (8.3 to 14.6) for revision TKR and from 18.3 (11.6 to 28.9) to 12.5 (9.3 to 16.8) for revision THR, but no significant reduction in reimbursement was estimated. The estimated effect of year of surgery remained similar when patient characteristics were included. Conclusions Length of stay for joint replacement fell substantially from 1997 to 2014. These reductions have translated into substantial savings. While patient characteristics affect length of stay and reimbursement, patient profiles have remained broadly stable over time. The observed reductions appear to be mostly explained by improved efficiency.
Burn, E., Edwards, C. J., Murray, D. W., Silman, A., Cooper, C., Arden, N. K., Pinedo-Villanueva, R., Prieto-Alhambra, D.
BMJ Publishing
2044-6055
20446055
shingle_title_1 Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS hospital records from 1997 to 2014
shingle_title_2 Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS hospital records from 1997 to 2014
shingle_title_3 Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS hospital records from 1997 to 2014
shingle_title_4 Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS hospital records from 1997 to 2014
timestamp 2025-06-30T23:32:17.762Z
titel Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS hospital records from 1997 to 2014
titel_suche Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: evidence from linked primary care and NHS hospital records from 1997 to 2014
topic WW-YZ
uid ipn_articles_6148017