BACKGROUND: Payers of health services and policymakers place a major focus on 
cost containment in health care. Studies have shown that early planning of 
discharge is essential in reducing length of stay and achieving financial 
benefit; tools that can help predict discharge disposition would therefore be of 
use. The Risk Assessment and Prediction Tool (RAPT) is a preoperative survey 
constructed to predict discharge disposition after total joint arthroplasty 
(TJA). The RAPT was developed and tested on a population of Australian patients 
undergoing joint replacement, but its validity in other populations is unknown. 
A low RAPT score is reported to indicate a high risk of needing any form of 
inpatient rehabilitation after TJA, including short-term nursing facilities.
QUESTIONS/PURPOSES: This study attempts (1) to assess predictive accuracy of the 
RAPT on US patients undergoing total hip and knee arthroplasty (THA/TKA); and 
(2) to determine predictive accuracy of each individual score (1-12).
METHODS: Between June 2006 and December 2011, RAPT scores of 3213 patients (1449 
THAs; 1764 TKAs) were prospectively captured during the preoperative clinical 
visit. Scores were stored along with other clinical data, including discharge 
disposition, in a dedicated database on a secure server. The database was 
queried by the nursing case manager to retrieve the RAPT scores of all patients 
captured during this time period. Binary logistic regression was used to analyze 
the scores and determine predictive accuracy.
RESULTS: Overall predictive accuracy was 78%. RAPT scores<6 and >10 (of 12) 
predicted with >90% accuracy discharge to inpatient rehabilitation and home, 
respectively. Predictive accuracy was lowest for scores between 7 and 10 at 
65.2% and almost 50% of patients received scores in this range. Based on our 
findings, the risk categories in our populations should be high risk<7, 
intermediate risk 7 to 10, and low risk>10.
CONCLUSIONS: The RAPT accurately predicted discharge disposition for high- and 
low-risk patients in our cohort. Based on our data, intermediate-risk patients 
should be defined as those with scores of 7 to 10. Predictive accuracy for these 
patients could potentially be improved through the identification and addition 
of other factors correlated to discharge disposition. The RAPT allows for 
identification of patients who are likely to be discharged home or to 
rehabilitation, which may facilitate preoperative planning of postoperative 
care. Additionally, it identifies intermediate-risk patients and could be used 
to implement targeted interventions to facilitate discharge home in this group 
of patients.
LEVEL OF EVIDENCE: Level III, diagnostic study. See the Guidelines for Authors 
for a complete description of levels of evidence.