Article

OBJECTIVE: To compare functional outcomes at discharge across postacute settings.
DESIGN: Prospective observational cohort study. SETTING: Eleven inpatient
rehabilitation facilities (IRFs), 8 freestanding skilled nursing facilities
(SNFs), and 1 hospital-based SNF from across the United States. PARTICIPANTS:
Consecutively enrolled patients (N=2152): patients with knee replacement (n=1401)
and patients with hip replacement (n=751). INTERVENTIONS: None; examination of
existing practice patterns. MAIN OUTCOME MEASURE: FIM discharge motor score.
RESULTS: Freestanding SNF patients entered with higher motor FIM scores and left
with higher scores than did IRF patients. IRF patients, however, achieved larger
motor FIM gains and achieved them in a shorter time. In multivariate models
controlling for patient differences and onset days, IRFs were associated with
better discharge motor outcomes, but the overall setting effect was not large.
The largest motor FIM differences were between medium-volume IRFs and low-volume
freestanding SNFs: 4.6 motor FIM points for patients with knee replacement and
7.3 motor FIM points for patients with hip replacement. Other differences between
settings were much smaller. Multivariate models explained between a third and a
half of the variance in outcome. CONCLUSIONS: As a group, IRFs had better motor
FIM outcomes than did SNFs, but the size of the IRF advantage was not large.
Other important facility and practice characteristics also were associated with
discharge outcomes after joint replacement rehabilitation. Earlier and more
intensive rehabilitation was associated with better outcomes. The volume of joint
replacement patients seen by a facility also plays a part: medium-volume
facilities among both SNFs and IRFs had better outcomes.

Langue : ANGLAIS