Long-Term Outcomes of Joint Replacement Rehabilitation Patients Discharged From Skilled Nursing and Inpatient Rehabilitation Facilities

Abstract 

DeJong G, Tian W, Smout RJ, Horn SD, Putman K, Hsieh C-H, Gassaway J, Smith P. Long-term outcomes of joint replacement rehabilitation patients discharged from skilled nursing and inpatient rehabilitation facilities.

Objective

To examine functional and health status outcomes of patients with joint replacement discharged from a skilled nursing facility (SNF) or an inpatient rehabilitation facility (IRF).

Design

Postdischarge follow-up interview study at 7.5 months after admission.

Setting

Five freestanding SNFs, 1 hospital-based SNF, and 6 IRFs.

Participants

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

Interventions

None.

Main Outcome Measures

FIM and Short-Form 12-Item Health Survey (SF-12).

Results

Among patients with knee and hip replacement, IRF patients made larger motor FIM gains from admission and discharge to follow-up. IRF patients, however, were admitted with lower FIM scores and also had more to gain (especially given the ceiling effects within the FIM at follow-up). When adjusted for case mix, IRF patients made larger motor FIM gains and had higher SF-12–related scores among patients with hip replacement but not among patients with knee replacement. Multivariate regressions found modest setting effects that favored IRFs, and the setting effects explained only a modest portion of the variance in motor FIM outcomes.

Conclusions

At follow-up, patients with joint replacement discharged from IRFs had better motor FIM outcomes than those discharged from freestanding SNFs and the hospital-based SNF. Settings did not differ materially in terms of SF-12 outcomes. Findings do not favor one setting decisively over another. A sole focus on initial postacute placement overlooks the larger trajectory of postacute care that needs to be managed to achieve superior outcomes.

Key Words: Arthroplasty, replacement, hip, Arthroplasty, replacement, knee, Rehabilitation, Rehabilitation centers, Skilled nursing facilities, Treatment outcome

List of Abbreviations: BMI, body mass index, CMG, case-mix group, CMS, Centers 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 (JOINTS I), LOS, length of stay, PCS, physical component summary, PPS, prospective payment system, SF-12, Short-Form 12-Item Health Survey, SNF, skilled nursing facility