title: Comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after hip fracture repair.
abstract: OBJECTIVE
  To examine differences in rehabilitation outcomes across 3 post-acute care (PAC) rehabilitation settings for patients after hip fracture repair.
  
  
  METHODS
  Prospective, observational cohort study.
  
  
  METHODS
  Six skilled nursing facilities (SNFs), 4 inpatient rehabilitation facilities (IRFs), and 8 home health agencies (HHAs) in 10 states.
  
  
  METHODS
  Patients (N=181) receiving PAC rehabilitation following hip fracture with internal fixation (n=116) or total hip replacement (n=64), or no surgical intervention (n=1).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Self-care and mobility status at PAC discharge measured by the Inpatient Rehabilitation Facility Patient Assessment Instrument.
  
  
  RESULTS
  IRF and HHA patients had lower self-care function at discharge relative to SNF patients controlling for patient characteristics, severity, comorbidities, and services. Adding length of stay (LOS) resulted in nonsignificant differences between IRFs and SNFs. In contrast, there was no setting-specific advantage in discharge mobility for patients with or without the addition of LOS. The average LOS of HHA patients was 2 weeks longer than that of SNF patients, whose average LOS was 9 days longer than that of IRF patients (average, 15d). IRF and SNF patients received about the same total minutes of therapy over their PAC stays (∼2100min on average), whereas HHA patients received only approximately 25% as many minutes.
  
  
  CONCLUSIONS
  Setting-specific effects varied depending on whether self-care or mobility was the outcome of focus. It remains unclear to what extent rehabilitation intensity or natural recovery effects changes in functional status for patients with hip fracture. This study points to important directions for PAC setting comparative effectiveness studies in the future, including uniform measurement, limited consensus on factors affecting recovery, accounting for selection bias, and using end-point data collection that is at the same follow-up time periods for all settings.
authors.affiliation: Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL. Electronic address: trudy@gwu.edu.
authors.forename: Trudy
authors.initials: T
authors.lastname: Mallinson
authors.affiliation: Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; RTI International, Waltham, MA; Rehabilitation Institute of Chicago, Chicago, IL; Center for Healthcare Studies, Northwestern University, Chicago, IL.
authors.forename: Anne
authors.initials: A
authors.lastname: Deutsch
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL.
authors.forename: Jillian
authors.initials: J
authors.lastname: Bateman
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL.
authors.forename: Hsiang-Yi
authors.initials: HY
authors.lastname: Tseng
authors.affiliation: Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies, Northwestern University, Chicago, IL.
authors.forename: Larry
authors.initials: L
authors.lastname: Manheim
authors.affiliation: Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Center for Healthcare Studies, Northwestern University, Chicago, IL.
authors.forename: Orit
authors.initials: O
authors.lastname: Almagor
authors.affiliation: Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Rehabilitation Institute of Chicago, Chicago, IL; Center for Healthcare Studies, Northwestern University, Chicago, IL.
authors.forename: Allen W
authors.initials: AW
authors.lastname: Heinemann
mesh_terms: D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D064650:Home Health Nursing / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010351:Patient Discharge; D011446:Prospective Studies; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012648:Self Care; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: HHA; Hip fracture; IRF; LOS; OT; PAC; Recovery of function; Rehabilitation; SNF; Skilled nursing facilities; home health agency; inpatient rehabilitation facility; length of stay; occupational therapy; post-acute care; skilled nursing facility