title: Long-term outcomes of joint replacement rehabilitation patients discharged from skilled nursing and inpatient rehabilitation facilities.
abstract: 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.
authors: Center for Post-acute Studies, National Rehabilitation Hospital, Washington, DC 20010, USA. Gerben.DeJong@MedStar.net
authors: Gerben
authors: G
authors: DeJong
authors: Wenqiang
authors: W
authors: Tian
authors: Randall J
authors: RJ
authors: Smout
authors: Susan D
authors: SD
authors: Horn
authors: Koen
authors: K
authors: Putman
authors: Ching-Hui
authors: CH
authors: Hsieh
authors: Julie
authors: J
authors: Gassaway
authors: Pamela
authors: P
authors: Smith
mesh_terms: 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