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Changes in Payment Regulation and Acute Care Use for Total Hip Replacement: Trends in Length of Stay, Costs, and Discharge, 1997–2012

Cary, Michael P. Jr. PhD, RN1; Baernholdt, Marianne PhD, MPH, RN, FAAN2; Merwin, Elizabeth I. PhD, RN, FAAN1

Rehabilitation Nursing Journal: March 2016 - Volume 41 - Issue 2 - p 67–77
doi: 10.1002/rnj.210
Continuing Education

Purpose: To describe trends in the length of stay (LOS), costs, mortality, and discharge destination among a national sample of total hip replacement (THR) patients between 1997 and 2012.

Design: Longitudinal retrospective design

Methods: Descriptive analysis of the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample data.

Findings: A total of 3,516,636 procedures were performed over the study period. Most THR patients were women, and the proportion aged 44–65 years increased. LOS decreased from 5 to 3 days. Charges more than doubled, from $22,184 to $53,901. Deaths decreased from 43 to 12 deaths per 10,000 patients. THR patients discharged to an institutional setting declined, while those discharged to the community increased.

Conclusion: We found an increase in THR patients, who were younger, women, had private insurance, and among those discharged to community-based settings.

Clinical Relevance: Findings have implications for patient profiles, workplace environments, quality improvement, and educational preparation of nurses in acute and postacute settings.

1Duke University, School of Nursing, Durham, NC, USA

2Virginia Commonwealth University, School of Nursing, Richmond, VA, USA

Published online 27 March 2015.


Michael P. Cary, Jr., Assistant Professor, School of Nursing, Duke University, DUMC 3322, 307 Trent Drive, Durham, NC 27710.


Grant number: 1F31NR012402–01A1; Grant sponsor: Barbara Brodie Scholars Endowment Award.

© 2016 Association of Rehabilitation Nurses.
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