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In addition, the fastest operating times and shortest patient stays were at a hospital where patients with TKR were served by a team of anesthesia doctors, scrub techs, and nurses specializing in arthroplasty. And the health care system that involved patients prior to surgery in their discharge planning process and managed patient expectations about disposition after hospitalization had shorter hospitalizations. Given the HVHC focus on the acute care and surgical processes, it is not surprising that they did not focus on what happened after hospital discharge following a TKR.
I believe that relying on RCTs will not get us where we need to be by In my opinion, the urgent need is for the creation of a High Value Rehabilitation Care Collaborative HVRC , which has as its core mission taking a pragmatic approach to rehabilitation systems science that will accumulate and disseminate new systems knowledge through innovation in local post—acute care and rehabilitation settings.
As with the HVHC, creating the HV R C would require a small group of innovative institutions ie, positive deviants to join together around a common rehabilitation condition or shared set of clinical questions.
For example, an HVRC could focus on a question regarding the variation in post—acute care services and settings following TKR or on a broader question, such as the role of post—acute care and rehabilitation services in altering the risk of hospital readmission within 30 days of discharge. The challenges to forming an HVRC are considerable and beyond the scope of one editorial to discuss.
A fundamental requirement is that HVRC members would need to agree on the use of a common set of advanced process and outcome measures so that critical data elements can be aggregated and analyzed to address each question of interest. Fortunately, the creation of entities such as the Physical Therapy Outcomes Registry 6 may make it more feasible today to implement a common set of measures across institutions to allow an HVRC to take root and begin to apply systems science in rehabilitation. In future editorials, I will discuss the challenge of how we disseminate practice innovations once they are achieved, so that the results of real-time learning regarding the quality, safety, and effectiveness of rehabilitation care can be adopted in a widespread manner across the US health care system.
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