Date of Completion of Thesis/SIP

Spring 6-26-2020

Document Type

Scholarly Inquiry Paper (SIP)

Degree Name

Master of Science in Nursing (MSN)



First Advisor

Kimberly Langer, DNP, APRN, CNP, ACNP-BC, FNP-BC

Second Advisor

Diane Forsyth, PhD, RN


From 2002 to 2013, there was an increase in the number of total joint replacement procedures performed as well as a rise in healthcare costs associated with such procedures. The Affordable Care Act of 2012 leveraged a shift in Medicare reimbursement from a fee-for-model (a payment model where services are paid separately) to a bundled payment method linked to quality of care. Joint replacement surgeries, specifically total knee arthroplasties (TKA), are one of the largest procedural expenditures for Medicare. To reduce costs, care associated with a TKA procedure was bundled to include all aspects of the procedure including post-operative supportive cares. Care pathways have been highly researched across the country as an effective method to reduce healthcare cost without comprising the quality of care. The goal of care pathways is to provide a seamless, structured care process that enhances decreased length of hospital stay, thus decreasing cost, while still maintaining an excellent quality of care.

Unfortunately, there is no standard care pathway for a TKA , although medical institutions may develop their own care pathway based on the requirements of Medicare reimbursement and their quality of care standards. The purpose of this scholarly inquiry paper assess for modalities of treatment for a clinical care pathway. Current literature supports the use of care pathways with a focus on structure, process and outcomes of total knee arthroplasty with the intent on reducing cost of care. Future recommendations based on the evidence supports the implementation of standardized care pathways that focuses on preoperative, intraoperative, and postoperative care for TKA procedures that meet a national standard, while maintaining quality care and taking into account the needs of each individual institution.


The completion of this scholarly inquiry paper could not have been possible without the encouragement, support and assistance of the Mayo Clinic Health System, Mankato Orthopedic department and process optimization acceleration workgroup. The work of Dr. Jacob Zeigler and Shane Lohmann M.B.A. were instrumental in this success of this undertaking. A sincere thank you to my advisor Dr. Kimberly Langer for her mentorship, guidance and all support over the course of my academic career.

Included in

Nursing Commons



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