A Risk Assessment Tool Based on Orthopedic Psychosocial and Health Status Factors is Associated with Post-Acute Resources

Abstract Background We implemented a risk assessment tool (RAT) used by clinical navigators to quantify pre-operative mobility, home safety, social/cognitive barriers, and patient health history. We sought to determine if this RAT is associated with the need for post-acute care (PAC) services defined as inpatient rehabilitation and skilled nursing facility, home health, and none (home) following total joint arthroplasty (TJA). Methods The study sample was comprised of a total of 1,438 primary TJA patients included in a bundled payment model. The RAT score, which ranges from 0 to 100, with higher scores representing healthier, more independent patents, was the key independent variable and post-acute service was the primary outcome variable. Results The median RAT score was 83 (IQR 78, 87.5) for no PAC discharges compared to 74 (IQR 67, 81) for inpatient PAC discharges (p Conclusion The RAT that is based on psychosocial, cognitive, environmental factors, and health status was significantly associated with the need for PAC services. The next step is to build and validate a real time, risk adjustment model to assist physicians and patients with planning post-discharge resources.