Data from hospitals in the MOHLTC hip and knee bundled care pilot indicate more than two-thirds of patients require multiple rehab services following total joint replacement. The findings suggest the current funding model does not reflect the costs of providing care to complex patients.

Working with its members, the Network tracked patients in the bundled care pilot who received inpatient and outpatient rehab between October and December 2018 and were identified as complex. (In inpatient rehab, this included patients with a stay longer than 10 days or who experienced complex clinical issues. In outpatient rehab, this included patients who were referred from inpatient rehab, experienced complex clinical issues or had a longer than expected number of attendance days.)

The data showed the following:

  • More than two-thirds of patients require multiple rehab services following total joint replacement.
    • Inpatient rehab: 84% of individuals with complex hip or knee replacement were admitted to another rehab service in addition to inpatient rehab.
    • Outpatient rehab: 50% of individuals with complex hip or knee replacement were admitted to another rehab service in addition to outpatient rehab.
  • The top clinical issues in complex cases are varied.
    • Inpatient rehab: Clinical issues included history/comorbidities affecting function and recovery (24%); slow to progress functionally (22%); home environment and supports delaying discharge (17%); and cognitive status affecting rehab participation (17%).
    • Outpatient rehab: Clinical issues included history/comorbidities affecting function and recovery (22%); physical or anatomical issues related to limitations in range of motion/limitations in joint range of motion/muscle strength (21%); and the need for individual treatment (17%).

The findings have been presented to the TC LHIN Orthopaedic Planning Committee.

For more information, contact project manager Sharon Ocampo-Chan.