Article

OBJECTIVE: To examine functional and health status outcomes of patients with
joint replacement discharged from a skilled nursing facility (SNF) or an
inpatient rehabilitation facility (IRF). DESIGN: Postdischarge follow-up
interview study at 7.5 months after admission. SETTING: Five freestanding SNFs, 1
hospital-based SNF, and 6 IRFs. PARTICIPANTS: Patients (N=856): 561 with knee
replacement and 295 with hip replacement. INTERVENTIONS: None. MAIN OUTCOME
MEASURES: FIM and Short-Form 12-Item Health Survey (SF-12). RESULTS: Among
patients with knee and hip replacement, IRF patients made larger motor FIM gains
from admission and discharge to follow-up. IRF patients, however, were admitted
with lower FIM scores and also had more to gain (especially given the ceiling
effects within the FIM at follow-up). When adjusted for case mix, IRF patients
made larger motor FIM gains and had higher SF-12-related scores among patients
with hip replacement but not among patients with knee replacement. Multivariate
regressions found modest setting effects that favored IRFs, and the setting
effects explained only a modest portion of the variance in motor FIM outcomes.
CONCLUSIONS: At follow-up, patients with joint replacement discharged from IRFs
had better motor FIM outcomes than those discharged from freestanding SNFs and
the hospital-based SNF. Settings did not differ materially in terms of SF-12
outcomes. Findings do not favor one setting decisively over another. A sole focus
on initial postacute placement overlooks the larger trajectory of postacute care
that needs to be managed to achieve superior outcomes.

Langue : ANGLAIS