Article

OBJECTIVE: To examine differences in rehabilitation outcomes across 3 post-acute
care (PAC) rehabilitation settings for patients after hip fracture repair.
SETTING: Six skilled nursing
facilities (SNFs), 4 inpatient rehabilitation facilities (IRFs), and 8 home
health agencies (HHAs) in 10 states. PARTICIPANTS: Patients (N=181) receiving PAC
rehabilitation following hip fracture with internal fixation (n=116) or total hip
replacement (n=64), or no surgical intervention (n=1). INTERVENTIONS: Not
applicable. MAIN OUTCOME MEASURE: Self-care and mobility status at PAC discharge
measured by the Inpatient Rehabilitation Facility Patient Assessment Instrument.
RESULTS: IRF and HHA patients had lower self-care function at discharge relative
to SNF patients controlling for patient characteristics, severity, comorbidities,
and services. Adding length of stay (LOS) resulted in nonsignificant differences
between IRFs and SNFs. In contrast, there was no setting-specific advantage in
discharge mobility for patients with or without the addition of LOS. The average
LOS of HHA patients was 2 weeks longer than that of SNF patients, whose average
LOS was 9 days longer than that of IRF patients (average, 15d). IRF and SNF
patients received about the same total minutes of therapy over their PAC stays (
approximately 2100min on average), whereas HHA patients received only
approximately 25% as many minutes. CONCLUSIONS: Setting-specific effects varied
depending on whether self-care or mobility was the outcome of focus. It remains
unclear to what extent rehabilitation intensity or natural recovery effects
changes in functional status for patients with hip fracture. This study points to
important directions for PAC setting comparative effectiveness studies in the
future, including uniform measurement, limited consensus on factors affecting
recovery, accounting for selection bias, and using end-point data collection that
is at the same follow-up time periods for all settings.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS