title: Variation in access to community rehabilitation services and length of stay in hospital following a hip fracture: a cross-sectional study.
abstract: OBJECTIVE
  To assess variation in access to and use of community rehabilitation services for patients with a hip fracture, and whether this affects length of stay in hospital.
  
  
  METHODS
  Cross-sectional study using administrative patient-level data from Hospital Episode Statistics (HES) and organisational survey data.
  
  
  METHODS
  A regional health economy in South West England served by four acute National Health Service (NHS) hospital trusts and six former Primary Care Trusts (PCTs).
  
  
  METHODS
  1230 hip fracture patients treated in an acute hospital between 1 April 2011 and 29 February 2012.
  
  
  RESULTS
  Information about access to community rehabilitation services for each acute hospital and PCT, reported by organisational survey. Rates of patients transferred from acute hospital to community rehabilitation hospitals (CRH) across eight groups with varying access; determined by acute hospital and PCT. Median lengths of stay in the acute hospital, and in the acute hospital plus CRH combined. Associations between the rate of transfer to a CRH and median lengths of stay assessed using Spearman's rank correlation coefficient (rs).
  
  
  RESULTS
  Access to community rehabilitation services varied, including the number of CRH inpatient beds, formal access criteria and waiting times. In one PCT, no home-based rehabilitation service was available. The percentage of patients transferred to a CRH ranged from 2.1% to 54.7%. A higher transfer rate was associated with a shorter median length of stay in the acute hospital (rs=-0.8; p=0.01), but a longer median combined length of stay in the acute hospital and CRH (rs=+0.7; p=0.04).
  
  
  CONCLUSIONS
  Within one geographical area, there was wide variation in availability and use of community rehabilitation services for patients discharged from an acute hospital following a hip fracture. Reliance on transfers to community rehabilitation hospitals was associated with a longer length of stay in the NHS.
authors.affiliation: Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Neuburger
authors.affiliation: Frenchay Hospital, North Bristol NHS Trust, Bristol, UK.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Harding
authors.affiliation: University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: Rachel J D
authors.initials: RJ
authors.lastname: Bradley
authors.affiliation: Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Cromwell
authors.affiliation: Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK Older Person's Unit, Royal United Hospital Bath NHS Trust, Bath, UK.
authors.forename: Celia L
authors.initials: CL
authors.lastname: Gregson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006620:Hip Fractures / Q000534:rehabilitation*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged
keywords: REHABILITATION MEDICINE