Use of Rehabilitation and Other Health Care Services by Patients With Joint Replacement After Discharge From Skilled Nursing and Inpatient Rehabilitation Facilities

Abstract 

DeJong G, Tian W, Smout RJ, Horn SD, Putman K, Smith P, Gassaway J, DaVanzo JE. Use of rehabilitation and other health care services by patients with joint replacement after discharge from skilled nursing and inpatient rehabilitation facilities.

Objective

To compare use of rehabilitation and other health services among patients with knee and hip replacement after discharge from a skilled nursing facility (SNF) or an inpatient rehabilitation facility (IRF).

Design

Follow-up interview study at 7.5 months after discharge.

Setting

Five freestanding SNFs, 1 hospital-based SNF, and 6 IRFs from across the United States.

Participants

Patients (N=856): patients with knee replacement (n=561) and patients with hip replacement (n=295).

Interventions

No interventions.

Main Outcome Measures

Number of home and outpatient therapy visits, physician visits, emergency room visits, rehospitalizations, and medical complications.

Results

After discharge from postacute care, the vast majority of patients received home rehabilitation, outpatient rehabilitation, or both. Patients with knee replacement received an average of 19 home and/or outpatient rehabilitation visits; patients with hip replacement received almost 15 visits. There were no statistically significant differences in rates of emergency room use and rehospitalization except that patients with hip replacement discharged from IRFs had higher rates of rehospitalization than those discharged from freestanding SNFs (15.8% vs 3.1%). Multivariate analyses did not find any SNF/IRF effects.

Conclusions

Patients with joint replacement from both SNFs and IRFs receive considerable amounts of follow-up rehabilitation care. Study uncovered no setting effects related to rehospitalization or medical complications. Looking only at care rendered in the initial postacute setting provides an incomplete picture of all care received and how it may affect follow-up outcomes.

Key Words: Arthroplasty, replacement, hip, Arthroplasty, replacement, knee, Hospital readmission, Rehabilitation, Rehabilitation centers, Skilled nursing facilities, Utilization

List of Abbreviations: BMI, body mass index, CMS, Center for Medicare and Medicaid Services, CSI, Comprehensive Severity Index, ER, emergency room, HMO, Health Maintenance Organization, IRF, inpatient rehabilitation facility, JOINTS I, Joint Replacement Outcomes in Inpatient Rehabilitation Facilities and Nursing Treatment Sites, JOINTS II, follow-up study to Joint Replacement Outcomes in Inpatient Rehabilitation Facilities and Nursing Treatment Sites, LOS, length of stay, OT, occupational therapy, PT, physical therapy, SNF, skilled nursing facility