The Clinical Pathway with Regional Alliance (CPRA) system for proximal femoral fractures in the southern region of Ibaraki prefecture: comparison of the proportion of patients who return to living at home from acute care and rehabilitation (kaihukuki) hospitals

Abstract

Objective: We investigated whether elderly patients treated for a proximal femoral fracture would be able to return home. Patients and Methods: The subjects of this study were 834 patients. We defined the acute care hospital group as patients who returned home from the acute care hospital and the kaihukuki group as patients who were transferred from an acute care hospital to a rehabilitation hospital. We recorded the proportion of patients who returned home. We also analyzed walking ability and the Barthel index (BI) of patients. Results: After 2013, the proportion of patients who returned home from the acute care hospital fell below 20%. The proportion of patients who returned home from the kaihukuki hospital stayed within the 75–85% range. The BI before injury and at discharge was 86 and 76 points, respectively, in the acute care hospital group. The acute care hospital group included patients who walked without an aid before the injury or when leaving the hospital. In the kaihukuki group, the BI before an injury, at admission, and at discharge from the rehabilitation hospital was 85, 56, and 74 points, respectively. In the kaihukuki group, the ability of patients to walk recovered more slowly than that of patients in the acute care hospital group. Conclusion: Walking ability and BI are important factors for determining whether patients with a proximal femoral fracture are able to return home.

Influence of patients’ walking ability at one-week post-proximal femur fracture surgery on the choice of discharge destination in Japan

“…We defined potential confounders that could intervene in the causal relationship between walking ability and postoperative outcome at one week. The selected confounding variables were age, fracture morphology, dementia, postoperative pneumonia, postoperative delirium, and preoperative walking ability, which have been shown by previous studies to affect postoperative outcomes 4,6,7) . The relationship between walking ability one week postoperatively and the defined confounders was tested by comparing the groups to derive a propensity score; nominal logistic regression analysis using the forced input method was performed with the dependent variable being walking ability one week postoperatively and the independent variable being the defined confounders.…”

“…However, the rate of patients returning home from acute care hospitals after proximal femur fracture surgery has been declining each year, and most patients are transferred to rehabilitation facilities or nursing homes 3,4) . As the need for homebased medical and nursing care increases, the socioeconomic burden on patients also increases, leading to public health problems, as such services are frequently not covered by insurance.…”

“…Therefore, it is necessary to consider patients' physical functions when determining their discharge destination. Suzuki et al investigated the relationship between postoperative physical function and outcome in patients with proximal femur fractures and reported that the group of patients who were discharged directly from the acute care hospital to their homes had significantly higher ambulation ability and Barthel Index (BI) scores at the time of discharge compared with the group of patients who were discharged to a rehabilitation facility 4) . BI is a scale used to measure a person's mobility and ability to perform activities of daily living independently; higher BI scores indicate a greater ability to function independently.…”