Long-term outcomes of joint replacement rehabilitation patients discharged from skilled nursing and inpatient rehabilitation facilities.
OBJECTIVE
To examine functional and health status outcomes of patients with joint replacement discharged from a skilled nursing facility (SNF) or an inpatient rehabilitation facility (IRF).


METHODS
Postdischarge follow-up interview study at 7.5 months after admission.


METHODS
Five freestanding SNFs, 1 hospital-based SNF, and 6 IRFs.


METHODS
Patients (N=856): 561 with knee replacement and 295 with hip replacement.


METHODS
None.


METHODS
FIM and Short-Form 12-Item Health Survey (SF-12).


RESULTS
Among patients with knee and hip replacement, IRF patients made larger motor FIM gains from admission and discharge to follow-up. IRF patients, however, were admitted with lower FIM scores and also had more to gain (especially given the ceiling effects within the FIM at follow-up). When adjusted for case mix, IRF patients made larger motor FIM gains and had higher SF-12-related scores among patients with hip replacement but not among patients with knee replacement. Multivariate regressions found modest setting effects that favored IRFs, and the setting effects explained only a modest portion of the variance in motor FIM outcomes.


CONCLUSIONS
At follow-up, patients with joint replacement discharged from IRFs had better motor FIM outcomes than those discharged from freestanding SNFs and the hospital-based SNF. Settings did not differ materially in terms of SF-12 outcomes. Findings do not favor one setting decisively over another. A sole focus on initial postacute placement overlooks the larger trajectory of postacute care that needs to be managed to achieve superior outcomes.
DeJong
Gerben
G
Center for Post-acute Studies, National Rehabilitation Hospital, Washington, DC 20010, USA. Gerben.DeJong@MedStar.net
Tian
Wenqiang
W
Smout
Randall J
RJ
Horn
Susan D
SD
Putman
Koen
K
Hsieh
Ching-Hui
CH
Gassaway
Julie
J
Smith
Pamela
P
D000368:Aged; D000704:Analysis of Variance; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010351:Patient Discharge; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000458:organization & administration*; D012866:Skilled Nursing Facilities / Q000458:organization & administration*; D019467:Subacute Care / Q000458:organization & administration*; D016896:Treatment Outcome; D014481:United States