Browsing by Author "Wild, Dana"
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Item Examination of discharge settings and readmission rates following hospitalization for total knee arthroplastyWelsh, Rodney Laine; Graham, James E; Ottenbacher, Kenneth; Karmarkar, Amol; Baillargeon, Jacques; Wild, Dana; Leland, NatalieTotal knee arthroplasty (TKA) is one of the most common surgical procedures performed in the United States with tremendous growth expected. Reducing unplanned hospital readmissions has become a focal point in minimizing healthcare cost within the Medicare population through several initiatives within the Patient Protection and Affordable Care Act (PPACA). Policy changes have also impacted the availability of post-acute care following TKA. Medicare’s 75% rule effectively limits the number of patients with unilateral TKA discharged to inpatient rehabilitation facilities (IRFs). The other two common post-acute settings include skilled nursing facilities (SNFs) and home- and community-based rehabilitation. We used Medicare data from beneficiaries who received TKA to examine 1) time trends in hospital discharge settings and 30-day readmission rates by discharge setting, 2) predictors of hospital discharge setting, and 3) factors associated with 30-day and 90-day readmission rates and reasons for readmission following TKA. We showed that IRF discharge decreased approximately 20% from 2002 to 2010 making it the least utilized post-acute setting. In addition, trends in 30-day readmission rates were lowest in community discharge and relatively the same in SNF and IRF in all study years. Using IRF discharge as the reference, patients who received a bilateral procedure had lower odds of both SNF and community discharge; patients with more comorbidity had lower odds for community discharge and higher odds for SNF discharge; and patients who received their TKA from hospitals with lower TKA volumes had lower odds of SNF and community discharge. Patients that discharged to either SNF or IRF had greater likelihood of 30-day readmission and greater risk for 90-day readmission versus patients discharged to the community. We found similar reasons for readmission from each discharge setting and time period. This study examines the topic of discharge settings and their effect on unplanned hospital readmission following TKA. These findings provide new information to the growing knowledge base on post-acute utilization patterns and hospital readmission rates among older adults receiving TKA.Item Outcomes of Selective Percutaneous Myofascial Lengthening Surgery (SPML) In Children with Lower Extremity SpasticityWild, DanaCerebral palsy (CP) is a neurodevelopmental condition defined as a disorder of posture and movement that is caused by a nonprogressive abnormality of an immature brain which can result in spasticity (Paneth, 2006; Pelligrino, 2002). Children with spastic CP usually present with muscle stiffness which eventually leads to decreased range of motion (ROM) in the knee and ankle joints interfering with gait and functional mobility (Graham, 2003). The purpose of this study was to assess changes in dynamic ROM of the knee and ankle and functional mobility following Selective Percutaneous Myofascial Lengthening Surgery (SPML) in a group of children with spastic CP. SPML is a minimally invasive surgical procedure designed to lengthen tight muscles of the lower extremity. Subjective and objective measures were obtained from medical records and video tapes of gait. Pre-operative and follow–up videos of gait for 31 children with CP who underwent SPML surgery from 2006 to 2008 were evaluated retrospectively. The outcome measures considered for this study included sagittal plane kinematic parameters of the knee and ankle joint, gait speed, and functional mobility. Mixed model for repeated measures for the knee and ankle joint parameters were used to estimate the change in ROM. Statistically significant differences in ROM were found for most joint measurements at p<0.05 in pre and post-operative comparisons, except for plantarflexion at toe-off. There was no difference in gait speed. FMS ratings improved by 1 level at 5 m, 50 m, and 500 m distances. The results of this study indicate that the SPML surgery, can positively affect dynamic ROM of the knee and ankle during gait, as well as improve functional mobility at 5 m, 50 m, and 500 m. This study provides information regarding a minimally invasive surgical option for children with spastic CP.