Abstract
Objective
To examine differences in rehabilitation outcomes across 3 post-acute care (PAC) rehabilitation
settings for patients after hip fracture repair.
Design
Prospective, observational cohort study.
Setting
Six skilled nursing facilities (SNFs), 4 inpatient rehabilitation facilities (IRFs),
and 8 home health agencies (HHAs) in 10 states.
Participants
Patients (N=181) receiving PAC rehabilitation following hip fracture with internal
fixation (n=116) or total hip replacement (n=64), or no surgical intervention (n=1).
Interventions
Not applicable.
Main Outcome Measure
Self-care and mobility status at PAC discharge measured by the Inpatient Rehabilitation
Facility Patient Assessment Instrument.
Results
IRF and HHA patients had lower self-care function at discharge relative to SNF patients
controlling for patient characteristics, severity, comorbidities, and services. Adding
length of stay (LOS) resulted in nonsignificant differences between IRFs and SNFs.
In contrast, there was no setting-specific advantage in discharge mobility for patients
with or without the addition of LOS. The average LOS of HHA patients was 2 weeks longer
than that of SNF patients, whose average LOS was 9 days longer than that of IRF patients
(average, 15d). IRF and SNF patients received about the same total minutes of therapy
over their PAC stays (∼2100min on average), whereas HHA patients received only approximately
25% as many minutes.
Conclusions
Setting-specific effects varied depending on whether self-care or mobility was the
outcome of focus. It remains unclear to what extent rehabilitation intensity or natural
recovery effects changes in functional status for patients with hip fracture. This
study points to important directions for PAC setting comparative effectiveness studies
in the future, including uniform measurement, limited consensus on factors affecting
recovery, accounting for selection bias, and using end-point data collection that
is at the same follow-up time periods for all settings.
Keywords
List of abbreviations:
HHA (home health agency), IRF (inpatient rehabilitation facility), LOS (length of stay), OT (occupational therapy), PAC (post-acute care), SNF (skilled nursing facility)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 12, 2013
Footnotes
Supported by the National Institute on Disability and Rehabilitation Research and Training Center on Measuring Rehabilitation Outcomes and Effectiveness (grant no. H133B040032).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated (Mallinson, Tseng, Manheim, and Almagor).
A commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit on the author or one or more of the authors. Deutsch, Heinemann, and Bateman are employees of an inpatient rehabilitation facility.
Identification
Copyright
© 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
