Patterns of rehabilitation utilization after hip fracture in acute hospitals and skilled nursing facilities.
BACKGROUND
Hospitalized hip fracture patients may receive physical therapy (PT) in acute and/or postacute settings. Patterns of PT use may vary by patient, clinical, and hospital characteristics. These patterns can be analyzed if the acute and postacute stays are linked.


OBJECTIVE
We classified the following patterns of PT use: acute PT only, skilled nursing facility (SNF) PT only, acute and SNF PT, and no PT. For each pattern, we compared (1) characteristics of hip fracture patients, (2) length of stay (LOS), and (3) discharge outcomes.


METHODS
The study included 187,990 hospitalized hip fracture patients derived from Medicare administrative data.


METHODS
Dependent variables were PT use patterns, acute hospital and SNF LOS, total episode days of care, and discharge destination. Independent variables were demographic, clinical, and facility characteristics. PT use patterns were also used as independent variables in the LOS and discharge destination models.


RESULTS
Patterns of PT use were influenced by demographic and clinical characteristics such as age, race, and surgery type. Similarly, different LOS measures and discharge destinations varied by the PT use patterns. Patients receiving acute PT had longer acute LOSs; however, those patients who were subsequently transferred to SNFs had shorter SNF LOSs and total episode days of care. Patients utilizing PT were more likely to be discharged to home after the acute or SNF stay.


CONCLUSIONS
Disparities in PT use exist for subgroups of patients such as the elderly and blacks. Providers should determine the most appropriate setting for initiation of PT to achieve better discharge outcomes with efficient use of resources.
Harada
N D
ND
UCLA School of Medicine, Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Health Care System, California 90073, USA.
Chun
A
A
Chiu
V
V
Pakalniskis
A
A
D000368:Aged; D000369:Aged, 80 and over; D014487:Centers for Medicare and Medicaid Services, U.S.; D005260:Female; D006302:Health Services Research; D006620:Hip Fractures / Q000534:rehabilitation*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D016018:Least-Squares Analysis; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D014481:United States