With the help of physical therapist Deana Hicks, Barbara Boyher takes her first steps on stairs after having knee replacement surgery at the Meyer Orthopedic Center. Boyher underwent rehab therapy as part of the Joint Adventure program, which offers patients inpatient physical therapy over three days after their surgeries. The program is designed to help patients adapt and recover after surgery, allowing them to return home more quickly, usually within a few days of their procedure.For years, Judee Steward had suffered with severe pain in both of her knees. “I was living on pain pills, using a cane, anything I could do to get to work, to manage, to last the day. That’s how bad it was,” she says. “I did not have quality of life.”
Steward, who is a senior advocate with Cox’s Senior Advantage program, had tried a variety of treatments but says eventually she reached the point where a knee replacement was the best option. “My doctor showed me the X-rays – there just wasn’t any cartilage left between the joints and it was just time to get it done,” says Steward.
So, Steward became one of the first patients to enter Joint Adventure – Cox’s new total joint program – and on May 3 she was the first patient treated at the new Meyer Orthopedic Center.
She credits the program and the seamless care it provides with her success – she was able to return to work only five weeks after her surgery. And Steward is not alone.
While leaders won’t be able to fully evaluate data until they can collect information on patient outcomes after their six-month follow-ups with their physicians, early indicators point to a program that’s successfully preparing patients for surgery, treating them, rehabilitating them and getting them on the road to an improved quality of life with their new joint.
A team approach to care“Joint Adventure is different because it’s a real team approach to providing total joint care,” says Fred Lerche, director of musculoskeletal services.
Born from a working group with representatives from rehabilitation, nursing, Oxford Home Health, physician offices and other areas, the program is a five-step process that carefully and seamlessly leads each knee and hip joint replacement patient through their surgery and beyond.
Joint Adventure begins with a pre-surgery class for patients and their support person, or coach, about two weeks prior to the surgery. The goal is to create a prepared, confident patient and coach.
“In the class, we try to paint the entire picture for them from now to six months down the road,” Lerche says. “We talk them through the entire process, from which door they need to come in on the day of their surgery, through what to expect during their hospital stay, what exercises they need to do now and after surgery – it’s all about preparing the patient and putting their mind at ease.”
Currently, about 85 percent of patients having a hip or knee replacement are attending the class. While program leaders would like to see 100 percent compliance, they are happy that those attending are reporting satisfaction with the program.
Program leaders have worked hard to weave the patient-centered, information-driven, team-building approach outlined in the class through the rest of the Joint Adventure program.
“We’ve timed it so that often the group that attends the class together ends up having surgery on the same day – or nearly the same day – about two weeks later. They end up working their inpatient therapy together and it creates a bond. The patients encourage each other and it’s all a part of the seamless care we want to provide,” Lerche says.
While in the hospital, patients progress from individualized therapy to group therapy, from getting up and sitting on the side of the bed or in a chair to relearning how to go up and down stairs and get in and out of a car.
Steward says she found inpatient rehab incredibly helpful to her recovery.
“You have to learn how to walk again. I compensated so much trying to take the pain off my knees that I kind of walked with a waddle. They taught me how to feel like I had control again,” she says. “And the home health care I received with Connie from Oxford was extraordinary. She really helped me regain my usage and my function so I could get back to work.”
Early signs of successWhile Lerche and other leaders have big plans to evaluate patient outcomes, early indicators provide hints of the program’s achievements.
“Eighty percent of our patients are discharged to home,” says Lerche. “That’s a big indicator of success, that we’re able to safely get a patient back home, rather than into skilled nursing. Where do patients want to go? They want to go home.”
Some programs in their benchmark group have a discharge-to-home rate of 22 percent; Lerche says such rates are not uncommon.
Joint Adventure leaders are also optimistic based on the feedback they’re receiving from patients and from physicians.
“Patients are telling us they can do things they couldn’t do before. They can take walks with their grandkids. They are enjoying their lifestyle so much more,” he says.
“Sometimes you have programs that are great patient pleasers. Sometimes you have programs that are great staff satisfiers. But when you blend them both together – isn’t that what you want? That’s success, and that’s what differentiates our program from any other program in the area.”
Looking toward the futureThe population of people who will want or need a joint replaced is expanding at a rapid clip. The American Academy of Orthopaedic Surgery says experts predict a 673 percent rise in knee replacements alone by 2013. Lerche attributes this to not only the aging Baby Boomers, but to the increased durability of replacement joint components.
“Now, we’re going ahead and doing joint replacements on younger people, where 15 or 20 years ago we would have told that person to wait because the components weren’t going to last.”
Another reason for the expected increase? It’s Generation-X, the generation that gave rise to the extreme sports movement. As they age, experts predict they will need new joints, too.
“You see those extreme sports? There’s trauma taking place,” says Lerche.
The MOC was built, and Joint Adventure was designed, to handle this growth.
“The numbers are unbelievable. We have to prepare for that and that’s why Cox has committed an entire hospital to orthopedics. The volume is going to be there, and we’ve built with room to grow,” Lerche says.
As for Steward, count her as part of that growth. Not for the knee she had replaced in May, but for the one that will be replaced in December.
“Both of my knees were bad, and Dr. Wester (her orthopedic surgeon) told me I could choose which one to have replaced first. I picked the right knee, since that’s the one I drive with,” she laughs.
“They tell you the next one may not be like the first one, and I am aware as far as the level of commitment it takes to get yourself back to independence,” Steward says.
“But I love my new knee – I can go up and down the stairs, I’ve gone back to the gym and I’ve lost 25 pounds – and I know my next experience will be just as challenging but also just as gratifying as this one was.”
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