Abstract
Objective
To examine contextual (facility and community) and individual factors associated with
self-care and mobility outcomes among Medicare hip fracture patients receiving inpatient
rehabilitation.
Design
Retrospective cohort study of 3 linked data files: Inpatient Rehabilitation Facility–Patient
Assessment Instrument, Provider of Services, and Area Health Resources. Multilevel
modeling was used to examine the effects of contextual and individual factors on self-care
and mobility outcomes.
Setting
Inpatient rehabilitation facilities (IRFs).
Participants
Medicare hip fracture patients (N=35,264; mean age, 81y) treated in IRFs (N=1072)
in 2012.
Interventions
Not applicable.
Main Outcome Measures
Self-care (eating, grooming, bathing, upper and lower body dressing, toileting) and
mobility (walk/wheelchair, stairs) at discharge.
Results
Mean ± SD self-care and mobility scores at admission were 3.17±.87 and 1.24±.51, respectively;
mean ± SD self-care and mobility scores at discharge were 5.03±1.09 and 3.31±1.54,
respectively. Individual and contextual levels explained 44.4% and 21.6% of the variance
in self-care at discharge, respectively, and 19.5% and 1.9% of the variance in mobility
at discharge, respectively. At the individual level, age, race/ethnicity, cognitive
and motor FIM scores at admission, and tier comorbidities explained variance in self-care
and mobility; sex and length of stay explained variance only in self-care. At the
contextual level, facilities' case mix (mean patient age, percent non-Hispanic white,
mean self-care score at admission) and structural characteristics (rural location,
freestanding, for-profit ownership) explained variance only in self-care; facilities'
case mix (mean patient age, percent non-Hispanic white, percent living with social
support, mean mobility score at admission) explained variance in mobility. Community
variables were nonsignificant.
Conclusions
Individual and facility factors were significant predictors of discharge self-care
and mobility among Medicare hip fracture patients in IRFs. The findings may improve
quality of IRF services to hip fracture patients and inform risk adjustment methods.
Keywords
List of abbreviations:
CMS (Centers for Medicare and Medicaid Services), ES (effect size), IRF (inpatient rehabilitation facility), IRF-PAI (Inpatient Rehabilitation Facility–Patient Assessment Instrument), LOS (length of stay), MLM (multilevel modeling)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 30, 2016
Footnotes
Supported by a grant from the Duke University School of Nursing Office of Research Affairs (grant no. 453-0579), and by the National Institute of Nursing Research, Center for Adaptive Leadership in Symptom Science (grant no. P30NR014139).
Disclosures: none.
Identification
Copyright
© 2016 The American Congress of Rehabilitation Medicine.
