Rehabilitation after hip fracture--equal opportunity for all?
OBJECTIVE
To determine whether factors unrelated to clinical appropriateness affect use of physical and occupational therapy (PT/OT) in elderly Medicare patients with acute hip fracture.


METHODS
Bivariate and multivariate analysis of detailed clinical data retrospectively gathered from medical records and of nonclinical variables obtained through linkage with the American Hospital Association data base.


METHODS
297 randomly selected hospitals from 5 states.


METHODS
2,762 elderly Medicare patients hospitalized with a primary diagnosis of acute hip fracture who were hospitalized during 1981-1982 or 1985-1986.


METHODS
Observational study.


METHODS
Initiation and intensity of PT/OT while in the acute hospital.


RESULTS
We found evidence that factors not relevant to clinical appropriateness, such as race, hospital size, and state, significantly affect whether patients receive any PT/OT after acute fracture, as well as the intensity of PT/OT. For example, after controlling for patient clinical characteristics, we found that 63% of African-American patients received low-intensity PT/OT in comparison to 43% among non-African-American, and we found threefold differences among states both in initiation of PT/OT and in the intensity of its use. Overall, clinical characteristics had relatively greater influence on whether patients started PT/OT, whereas factors not relevant to clinical appropriateness had relatively greater influence on how much rehabilitation was provided.


CONCLUSIONS
There are significant disparities in use of rehabilitation after hip fracture, only partially explained by patient clinical characteristics. Factors without obvious relevance to the clinical appropriateness of PT/OT exert a significant influence on use of rehabilitation services, particularly on the intensity of their use.
Hoenig
H
H
Duke University Medical Center, Durham, NC, USA.
Rubenstein
L
L
Kahn
K
K
D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015276:Health Care Rationing / Q000706:statistics & numerical data*; D006620:Hip Fractures / Q000145:classification / Q000534:rehabilitation*; D006777:Hospitals, Proprietary / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000592:standards / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009789:Occupational Therapy Department, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D010814:Physical Therapy Department, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D011287:Prejudice; D011787:Quality of Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014481:United States