Disparities in post-acute rehabilitation care for joint replacement

Abstract

Objectives To determine the extent to which demographic and geographic disparities exist in the use of post-acute rehabilitation care (PARC) for joint replacement. Methods Cross-sectional analysis of two years (2005–2006) of population-based hospital discharge data from 392 hospitals in four states (AZ, FL, NJ, WI). 164,875 individuals 45 years and older admitted to the hospital for a hip or knee joint replacement and who survived their inpatient stay were identified. Three dichotomous dependent variables were examined: 1) discharge to home vs. institution (i.e., skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF)); 2) discharge to home with vs. without home health (HH); and 3) discharge to a SNF vs. IRF. Multilevel logistic regression analyses were conducted to identify demographic and geographic disparities in PARC use, controlling for illness severity/comorbidities, hospital characteristics, and PARC supply. Interactions among race, socioeconomic, and geographic variables were explored. Results Considering PARC as a continuum from more to less intensive care in regard to hours of rehabilitation/day (e.g., IRF→SNF→HH→no HH), the uninsured received less intensive care in all three models. Individuals on Medicaid and those of lower SES received less intensive care in the HH/no HH and SNF/IRF models. Individuals living in rural areas received less intensive care in the institution/home and HH/no HH models. The effect of race was modified by insurance and by state. In most instances minorities received less intensive care. PARC use varied by hospital. Conclusions Efforts to further understand the reasons behind these disparities and their effect on outcomes are needed.

Occupational Therapy Use by Older Adults With Cancer

“…Unlike in previous studies (Freburger et al, 2011;Harada, Chun, Chiu, & Pakalniskis, 2000), geographic location did not seem to be related to disparities in utilization. Harada et al (2000) examined the geographic location of the hospitals where adults with hip fractures received physical therapy and found location to be highly important.…”

“…Their findings may speak to the differences between health service use for urban and rural hospitals, not necessarily the county in which the adult lives as was examined in this study. Also, our finding could be related specifically to North Carolina; Freburger et al (2011) did not examine adults from North Carolina. It could also be specific to the use of health care after a diagnosis of cancer, which may be different than for other conditions (Au, Udris, Fihn, McDonell, & Curtis, 2006).…”

“…This finding could be considered encouraging because it suggests only a minimal difference based on race, and that difference gives the advantages to African-Americans. Freburger et al (2011) reported that sociodemographics predicted increased use of higher institutional rehabilitation. However, as Freburger et al described, even relatively small increases in use by minority groups may be concerning when considering the differences of outcomes and quality of survivorship for minorities overall (National Cancer Institute [NCI], 2011).…”

“…However, as Freburger et al described, even relatively small increases in use by minority groups may be concerning when considering the differences of outcomes and quality of survivorship for minorities overall (National Cancer Institute [NCI], 2011). Therefore, a small difference in use of services by minority compared with White patients may actually be more likely because of delayed, unmet health care needs and delayed use of services (Freburger et al, 2011;Moon & Shin, 2005).…”

Impact of Socioeconomic Factors on Outcome of Total Knee Arthroplasty

“…These findings are similar to those of a recent randomized trial reported by Butler et al [10] after cementless THA in which implant type had no impact on any outcome scores while patients from low-income households were associated with inferior clinical results. Freburger et al [22] reported low-income patients who underwent TKA received less postacute care rehabilitation services, a finding that could potentially contribute to the suboptimal clinical results observed in the low-income cohort in our study, although we did not collect rehabilitation data. While women reported lower satisfaction than men, the overall rate of dissatisfaction in this study was less than 10% or approximately 1 .…”