Social insurance preliminary agreement (MSAP) to enter PRM ward for patients after orthopedic surgery in Gonesse hospital.

OBJECTIVE: To evaluate the interest of social insurance preliminary agreement to enter PRM ward for patients after orthopedic surgery in Gonesse hospital.

MATERIAL/PATIENTS AND METHODS: From 01/01/15 to 06/30/15 went to PRM ward (inpatient or day hospital rehabilitation) 16 patients after TKA, 20 patients including 3 femoral neck fracture after THA, 3 patients after anterior cruciate knee ligamentoplasty and 3 patients with cuff tear surgery. At entrance, we assess patient's pain, mobility, personal and environmental factors upon Sofmer-Fedmer, MSAP and HAS standards.

RESULTS: All patients with arthroplasty have several impairments and associates complexity factors (ICF). All patients with knee ligamentoplasty or cuff tear surgery have a sport and/or a professional planning or post-op complication. They all need to enter a PRM ward upon Sofmer-Fedmer, MSAP and HAS standards.

DISCUSSION - CONCLUSION: Entering PRM ward is relevant according to Sofmer recommendations. Returning home after acute care and having outpatient physiotherapy does not fit these patients. We have to take into account their specific needs for rehabilitation and if necessary access to a specialized technical rehabilitation platform, and a multidisciplinary approach for specific impairments and activity limitations as well as quick access to specialists such as cardiologist, diabetologist, or chest specialist for patients at risk of postoperative decompensation. Referring patients to post-acute care facility after orthopedic surgery remain unchanged since 2013 because we still use the same standards for orientation based upon Sofmer-Fedmer clinical care pathways, MSAP criterion and HAS standards. MSAP procedure is complex, heavy on human resources and time. Is MSAP the appropriate criterion to manage financial risk according our authorities and for what kind of patients' outcome?