Benefits of home health care after inpatient rehabilitation for hip fracture: health service use by Medicare beneficiaries, 1987-1992.
OBJECTIVE
To examine the added benefit of home health services for elderly patients with hip fracture discharged home after inpatient rehabilitation.


METHODS
Medicare claims from 1% of 1986 beneficiaries followed until 1992.


METHODS
Persons hospitalized with hip fracture at 70 years or older who had no major Medicare claims during the year before hospitalization and who were discharged home after inpatient rehabilitation.


RESULTS
Rehospitalization and any nonskilled nursing facility (non-SNF) nursing home admission during the 12 months after hospital discharge.


RESULTS
Patients who received additional home health services (27.2%) were less likely to be hospitalized than those who received rehabilitation only (31.1%); they were also less likely to have a non-SNF nursing home admission (11.3% vs 23.3%), and more likely to survive the year with no subsequent Medicare claims (65.6% vs 55%). Propensity scores were used to adjust for nonrandom treatment selection in a Cox proportional hazards analysis showing that home health was associated with a significantly lower risk of nursing home admission (adjusted odds ratio = .42, 95% confidence interval .21-.84), and hospitalization (adjusted odds ratio = .65, 95% confidence interval .26-1.00).


CONCLUSIONS
Studies of the relative effectiveness of post-acute services and postdischarge evaluations of inpatient rehabilitation should consider additional home care as a postacute service and examine optimal postacute treatment to minimize additional service use.
Intrator
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Center for Gerontology and Health Care Research, Brown University, Providence, RI, USA.
Berg
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D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D019538:Health Care Surveys; D006620:Hip Fractures / Q000534:rehabilitation*; D006699:Home Care Services / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D008297:Male; D016345:Medicare Part B / Q000706:statistics & numerical data* / Q000639:trends; D009735:Nursing Homes / Q000706:statistics & numerical data*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D014481:United States