Determinants of postsurgical discharge setting for male hip fracture patients.
Veterans hospitalized for hip fracture repair may be discharged to one of several rehabilitation settings, but it is not known what factors influence postsurgical discharge setting. The purpose of the study was to examine the patient, facility, and market factors that influence the choice of postsurgical discharge setting. Using a retrospective cohort design, we linked 11,083 veterans who had hip fracture surgeries in a Department of Veterans Affairs (VA) hospital from 1998 to 2005 as assessed by the VA National Surgical Quality Improvement Program dataset with administrative data. The factors associated with five postdischarge settings were analyzed using multinomial logistic regression. We found that few veterans (0.8%) hospitalized for hip fracture were discharged with home health. Higher proportions of veterans were discharged to a nursing home (15.4%), to outpatient rehabilitation (18.8%), to inpatient rehabilitation (16.9%), or to home (48.2%). Patients were more likely to be discharged to nonhome settings for VA-provided rehabilitation if they had total function dependence, had American Society of Anesthesiologists class 4 or 5, had surgical complications prior to discharge, or lived in counties with lower nursing home bed occupancy rates. Future research should compare postsurgical and longer-term morbidity, mortality, and healthcare utilization across these rehabilitation settings.
Center for Health Services Research in Primary Care (152), Durham VA Medical Center, 508 Fulton St, Durham, NC 27705. matthew.maciejewski@va.gov.
Matthew L
ML
Maciejewski
Tiffany A
TA
Radcliff
William G
WG
Henderson
Diane
D
Cowper Ripley
W Bruce
WB
Vogel
Elizabeth
E
Regan
Evelyn
E
Hutt
D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D006620:Hip Fractures / Q000534:rehabilitation* / Q000601:surgery; D006787:Hospitals, Veterans; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data
Medicare; admission; discharge; hip fracture; home care; inpatient rehabilitation; nursing home; outpatient 
rehabilitation; treatment; veterans