Evidence map›Paper›PMID 41277482›Full record

ArticleJournal of the American Geriatrics Society2026

Trends in Discharge to Institutional Post-Acute Care After Total Joint Arthroplasty in the United States and Canada.

Chih-Ying Li, Yong-Fang Kuo, Md Ibrahim Tahashilder, Samantha S M Drover, Fangyun Wu, Bruce Landon, Bheeshma Ravi, Peter Cram

Abstract read
In one paragraph

Article in Journal of the American Geriatrics Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Chih-Ying LiDepartment of Occupational Therapy, School of Health Professions, University of Texas Medical Branch, Galveston, Texas, USA.ORCID 0000-0003-4817-554X
Yong-Fang KuoDepartment of Biostatistics & Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas, USA.ORCID 0000-0003-1927-0927
Md Ibrahim TahashilderDepartment of Biostatistics & Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas, USA.ORCID 0000-0001-8521-1461
Samantha S M DroverICES (Previously the Institute for Clinical and Evaluative Sciences), Toronto, Ontario, Canada.
Fangyun WuICES (Previously the Institute for Clinical and Evaluative Sciences), Toronto, Ontario, Canada.
Bruce LandonDepartment of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
Bheeshma RaviDivision of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
Peter CramICES (Previously the Institute for Clinical and Evaluative Sciences), Toronto, Ontario, Canada.

Funding

The Texas Resource Center on Minority Aging Research (RCMAR)P30AG059301 · NIA · UNIVERSITY OF TEXAS MED BR GALVESTON · PI Kyriakos S Markides, Fernando Riosmena · 2018 to 2026
$5.2M
Comparing hospitalization rates, outcomes, and treatment intensity for elderly patients across OECD countriesR01AG058878 · NIA · HARVARD MEDICAL SCHOOL · PI Peter M Cram, Bruce E. Landon · 2019 to 2026
$3.4M
Comparing approval, adoption/de-adoption and outcomes for advanced cardiovascular procedures across high-income countriesR01HL167887 · NHLBI · HARVARD MEDICAL SCHOOL · PI Peter M Cram, Bruce E. Landon · 2024 to 2026
$2.0M
Standardized Patient Assessment across Post-Acute Care: Opportunities and ChallengesK01HD101589 · NICHD · UNIVERSITY OF TEXAS MED BR GALVESTON · PI LI, CHIH-YING · 2020 to 2024
$632k
Ministry of Long-Term CareNHLBI NIH HHS R01 HL167887NIA NIH HHS P30 AG059301NIA NIH HHS R01 AG058878NICHD NIH HHS K01 HD101589NIH HHS K01HD101589NIH HHS R01AG058878NIH HHS R01HL167887Ontario Ministry of Health
6 · The paper itself

Abstract

backgroundRecent payment reforms in the United States have been credited with reducing the use of institutional post-acute care (PAC) after total knee arthroplasty (TKA) and total hip arthroplasty (THA). This dual-country study of Canada and the United States compares longitudinal trends in discharge to institutional PAC after primary TKA or THA.

methodsWe conducted serial cross-sectional analyses to compare discharge to institutional PAC trends among adults aged ≥ 66 years undergoing primary TKA or THA in the United States and Canada from 2013 to 2019. Patient-level data were obtained from population-based Medicare claims in the United States and analogous datasets in Ontario. Discharge trends were assessed using standardized differences and linear regression models to evaluate relative changes over time.

resultsPatients receiving TKA (2,308,001) and THA (1,234,149) in the United States and Ontario (106,721 and 53,371, respectively) were similar in age (73-74 years) and sex (~60% female). The absolute reduction in institutional PAC discharge over time for TKA was greater in the United States (slope = -3.59) than in Canada (slope = -0.53) (p < 0.0001), but relative reductions (slope = -8.78 in the United States, slope = -6.99 in Canada) were statistically similar (p = 0.08). THA showed a similar trend of absolute reductions; however, the relative reduction trend in the United States (slope = -9.98) was steeper than in Canada (slope = -6.46) (p = 0.0009).

conclusionsThe US payment reforms from 2013 to 2019 were associated with a greater impact on reducing institutional PAC utilization for THA than for TKA.

Indexed as

Arthroplasty, Replacement, HipArthroplasty, Replacement, KneePatient DischargeSubacute CareAgedAged, 80 and overCanadaCross-Sectional StudiesFemaleHumansMaleMedicareOntarioUnited Stateshealth services administrationinternational comparisonsMedicare payment advisory commissionoutcome and process assessmentsubacute care

Identifiers

PMID41277482
PMCPMC12833981

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.