Dataset Information

Postacute rehabilitation care for hip fracture: who gets the most care?

ABSTRACT:

Objectives

To determine the extent to which demographic and geographic disparities exist in postacute rehabilitation care (PARC) use after hip fracture.

Design

Cross-sectional analysis of 2 years (2005-06) of population-based hospital discharge data.

Setting

All short-term acute care hospitals in four demographically and geographically diverse states (AZ, FL, NJ, WI).

Participants

Individuals aged 65 and older (mean 82.9) admitted to the hospital with a hip fracture who survived their inpatient stay (N = 64,065). The sample was 75.1% female and 91.5% white, 5.8% Hispanic, and 2.7% black.

Measurements

Whether the participant received institutional PARC; for participants who did not receive institutional care, whether they received home health (HH) care; and for participants who received institutional care, whether they received skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF) care. Multilevel logistic regression analyses were conducted to identify demographic and geographic disparities in PARC use.

Results

Considering PARC on a continuum from more to fewer hours of care per day (IRF→SNF→HH→no HH), minorities and individuals of lower socioeconomic status (SES) generally received a lower volume of care. Individuals on Medicaid or who were uninsured were less likely to receive institutional care (odds ratio (OR) = 0.23, 95% confidence interval (CI) = 0.18-0.30) and to receive HH (OR = 0.46, 95% CI = 0.30-0.70) and more likely to receive SNF than IRF care (OR = 2.03, 95% CI = 1.36-3.05). Hispanics were less likely to receive institutional care (OR = 0.70, 95% CI = 0.62-0.79), and Hispanics (OR = 1.31) and blacks (OR = 1.49) were more likely to receive SNF than IRF care. There were also geographic differences in PARC.

Conclusion

Several demographic and geographic disparities in PARC use were identified. Future research should confirm these findings and further elucidate factors that contribute to the observed disparities.

SUBMITTER: Freburger JK

PROVIDER: S-EPMC3470736 | biostudies-literature | 2012 Oct

REPOSITORIES: biostudies-literature

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Publications

Postacute rehabilitation care for hip fracture: who gets the most care?

Freburger Janet K JK Holmes George M GM Ku Li-Jung E LJ

Journal of the American Geriatrics Society 20121004 10

<h4>Objectives</h4>To determine the extent to which demographic and geographic disparities exist in postacute rehabilitation care (PARC) use after hip fracture.<h4>Design</h4>Cross-sectional analysis of 2 years (2005-06) of population-based hospital discharge data.<h4>Setting</h4>All short-term acute care hospitals in four demographically and geographically diverse states (AZ, FL, NJ, WI).<h4>Participants</h4>Individuals aged 65 and older (mean 82.9) admitted to the hospital with a hip fracture ...[more]

PMID: 23036079

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Project description:ObjectiveProvision of early rehabilitation services during acute hospitalization after a hip fracture is vital for improving patient outcomes. The purpose of this study was to examine the association between the amount of rehabilitation services received during the acute care stay and hospital readmission in older patients after a hip fracture.MethodsMedicare claims data (2016-2017) for older adults admitted to acute hospitals for a hip fracture (n = 131,127) were used. Hospital-based rehabilitation (physical therapy, occupational therapy, or both) was categorized into tertiles by minutes per day as low (median = 17.5), middle (median = 30.0), and high (median = 48.8). The study outcome was risk-adjusted 7-day and 30-day all-cause hospital readmission.ResultsThe median hospital stay was 5 days (interquartile range [IQR] = 4-6 days). The median rehabilitation minutes per day was 30 (IQR = 21-42.5 minutes), with 17 (IQR = 12.6-20.6 minutes) in the low tertile, 30 (IQR = 12.6-20.6 minutes) in the middle tertile, and 48.8 (IQR = 42.8-60.0 minutes) in the high tertile. Compared with high therapy minutes groups, those in the low and middle tertiles had higher odds of a 30-day readmission (low tertile: odds ratio [OR] = 1.11, 95% CI = 1.06-1.17; middle tertile: OR = 1.07, 95% CI = 1.02-1.12). In addition, patients who received low rehabilitation volume had higher odds of a 7-day readmission (OR = 1.20; 95% CI = 1.10-1.30) compared with high volume.ConclusionElderly patients with hip fractures who received less rehabilitation were at higher risk of readmission within 7 and 30 days.ImpactThese findings confirm the need to update clinical guidelines in the provision of early rehabilitation services to improve patient outcomes during acute hospital stays for individuals with hip fracture.Lay summaryThere is significant individual- and hospital-level variation in the amount of hospital-based rehabilitation delivered to older adults during hip fracture hospitalization. Higher intensity of hospital-based rehabilitation care was associated with a lower risk of hospital readmission within 7 and 30 days.

Dataset Information

Postacute rehabilitation care for hip fracture: who gets the most care?

Objectives

Design

Setting

Participants

Measurements

Results

Conclusion

Publications

Postacute rehabilitation care for hip fracture: who gets the most care?

Similar Datasets

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