Comparison of Discharge Functional Status After Rehabilitation in Skilled Nursing, Home Health, and Medical Rehabilitation Settings for Patients After Hip Fracture Repair

Mallinson, Trudy; Deutsch, Anne; Bateman, Jillian; Tseng, Hsiang Yi; Manheim, Larry M.; Almagor, Orit; Heinemann, Allen W.

doi:10.1016/j.apmr.2013.05.031

Cited by 71 publications

(84 citation statements)

References 20 publications

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“…This is consistent with previous studies indicating hip fracture patients who lived with others prior to admission had poorer self-care and mobility scores at admission. 2,10 …”

Section: Discussionmentioning

confidence: 99%

“…1 In general, evidence suggests hip fracture patients who receive intensive rehabilitation demonstrate positive functional gains; 2–4 these studies focused largely on patient factors. Little evidence exists on the influence of facility characteristics (e.g., case mix, structural characteristics) associated functional outcomes among hip fracture patients.…”

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confidence: 99%

“…Little evidence exists on the influence of facility characteristics (e.g., case mix, structural characteristics) associated functional outcomes among hip fracture patients. 2, 5–7 Moreover, rehabilitation researchers have increasingly recognized the importance of environmental contexts of care (e.g., demographic and socioeconomic characteristics of the community) that may result in health disparities 2,5–7 and impact the use of rehabilitation services and outcomes. 8 To our knowledge, no studies have been conducted that account for both contextual (facility and community) and patient factors that might contribute to the variation in functional outcomes among hip fracture patients following inpatient rehabilitation.…”

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confidence: 99%

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Self-Care and Mobility Following Postacute Rehabilitation for Older Adults With Hip Fracture: A Multilevel Analysis

Cary

Pan

Sloane

et al. 2016

Archives of Physical Medicine and Rehabilitation

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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) treated in IRFs (N = 1072) in 2012. Interventions Not applicable. Main Outcome Measure(s) Self-care (eating, grooming, bathing, upper and lower body dressing, and toileting) and mobility (walk/wheelchair and stairs) at discharge. Results Mean age was 81 years. Mean self-care and mobility scores at admission were 3.17 (SD=0.87) and 1.24, (SD=0.51), respectively; mean self-care and mobility scores at discharge were 5.03 (SD=1.09) and 3.31 (SD=1.54), respectively. Individual and contextual levels explained 44.4% and 21.6% of the variance in self-care at discharge and 19.5% and 1.9% of the variance in mobility at discharge, respectively. Individual level, age, race/ethnicity, cognitive and motor FIM scores at admission, and Tier comorbidities explained variance in self-care and mobility; gender 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, and for-profit ownership) explained variance only in self-care; facilities’ case mix (mean patient age, percent Non-Hispanic White, percent living with social support, and mean mobility score at admission) explained variance in mobility. Community variables were non-significant. Conclusion Individual and facility factors were significant predictors of discharge self-care and mobility among Medicare hip fracture patients in IRFs. Findings may improve quality of IRF services to hip fracture patients and inform risk adjustment methods.

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“…This is consistent with previous studies indicating hip fracture patients who lived with others prior to admission had poorer self-care and mobility scores at admission. 2,10 …”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Self-Care and Mobility Following Postacute Rehabilitation for Older Adults With Hip Fracture: A Multilevel Analysis

Cary

Pan

Sloane

et al. 2016

Archives of Physical Medicine and Rehabilitation

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“…Overall, longterm differences in outcomes between these different approaches have not been seen. 195 The transition period is one of particular vulnerability for the hip fracture patient. 196 Meticulous attention to detail in the discharge process is very important to decrease complications and readmissions.…”

Section: Rehabilitationmentioning

confidence: 99%

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Mears¹,

Kates²

2015

Geriatr Orthop Surg Rehabil

134

121

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Over the past 4 decades, much has been learned about the pathophysiology and treatment of osteoporosis, the prevention of fragility fractures, and the perioperative management of patients who have these debilitating injuries. However, the volume of published literature on this topic is staggering and far too voluminous for any clinician to review and synthesize by him or herself. This manuscript thoroughly summarizes the latest research on fragility fractures and provides the reader with valuable strategies to optimize the prevention and management of these devastating injuries. The information contained in this article will prove invaluable to any health care provider or health system administrator who is involved in the prevention and management of fragility hip fractures. As providers begin to gain a better understanding of the principles espoused in this article, it is our hope that they will be able to use this information to optimize the care they provide for elderly patients who are at risk of or who have osteoporotic fractures.

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“…The average length of stay for hip fracture rehabilitation in an IRF or SNF ranges from 15–27 days. 4 Hip fracture patients discharged to a SNF are often older and more likely to have cognitive impairment whereas IRF patients are more likely to have a greater number of comorbidities. 4,5 …”

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An Examination of the First 30 Days After Patients are Discharged to the Community From Hip Fracture Postacute Care

et al. 2015

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Background Post-acute care (PAC) rehabilitation aims to maximize independence and facilitate a safe community transition. Yet little is known about PAC patients’ success in staying home post-discharge or differences on this outcome across PAC providers. Objectives Examine the percentage of PAC patients who remain in the community at least 30 days after discharge (i.e., successful community discharge) following hip fracture rehabilitation and describe differences among PAC facilities based on this outcome. Research Design Retrospective observational study. Subjects Community-dwelling, Medicare fee-for-service beneficiaries 75 years of age and older who experienced their first hip fracture between 1999–2007 (n=880,779). PAC facilities admitting hip fracture patients in 2006. Measures Successful community discharge, sites of readmission after PAC discharge. Results Between 1999 and 2007, 57% of patients achieved successful community discharge. Black were less likely (adjusted odds ratios=0.84, 95% confidence interval 0.82–0.86) than similar whites to achieve successful community discharge. Among all who re-entered the community (n=581,095), 14% remained in the community fewer than 30 days. Acute hospitals (67.5%) and institutional PAC (16.8%) were the most common sites of re-entry. The median proportion of successful community discharge among facilities was 49% (IQR: 33%–66%). Lowest-quartile facilities admitted older (85.9 vs. 84.1 years of age), sicker patients (e.g., higher rates of hospital complications 6.0% vs. 4.6%), but admitted fewer annually (7.1 vs. 19.3), compared to the highest quartile. Conclusions Re-entry into the healthcare system after PAC community discharge is common. Due to the distinct care needs of the PAC population there is a need for a quality measure that complements the current 30-day hospital readmission outcome and captures the objectives of PAC rehabilitation.

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Comparison of Discharge Functional Status After Rehabilitation in Skilled Nursing, Home Health, and Medical Rehabilitation Settings for Patients After Hip Fracture Repair

Cited by 71 publications

References 20 publications

Self-Care and Mobility Following Postacute Rehabilitation for Older Adults With Hip Fracture: A Multilevel Analysis

Self-Care and Mobility Following Postacute Rehabilitation for Older Adults With Hip Fracture: A Multilevel Analysis

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

An Examination of the First 30 Days After Patients are Discharged to the Community From Hip Fracture Postacute Care

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