title: Self-Care and Mobility Following Postacute Rehabilitation for Older Adults With Hip Fracture: A Multilevel Analysis.
abstract: To examine contextual (facility and community) and individual factors associated with self-care and mobility outcomes among Medicare hip fracture patients receiving inpatient rehabilitation.
  
  
  
  Retrospective cohort study of 3 linked data files: Inpatient Rehabilitation Facility-Patient Assessment Instrument, Provider of Services, and Area Health Resources. Multilevel modeling was used to examine the effects of contextual and individual factors on self-care and mobility outcomes.
  
  
  
  Inpatient rehabilitation facilities (IRFs).
  
  
  
  Medicare hip fracture patients (N=35,264; mean age, 81y) treated in IRFs (N=1072) in 2012.
  
  
  
  Not applicable.
  
  
  
  Self-care (eating, grooming, bathing, upper and lower body dressing, toileting) and mobility (walk/wheelchair, stairs) at discharge.
  
  
  
  Mean ± SD self-care and mobility scores at admission were 3.17±.87 and 1.24±.51, respectively; mean ± SD self-care and mobility scores at discharge were 5.03±1.09 and 3.31±1.54, respectively. Individual and contextual levels explained 44.4% and 21.6% of the variance in self-care at discharge, respectively, and 19.5% and 1.9% of the variance in mobility at discharge, respectively. At the individual level, age, race/ethnicity, cognitive and motor FIM scores at admission, and tier comorbidities explained variance in self-care and mobility; sex and length of stay explained variance only in self-care. At the contextual level, facilities' case mix (mean patient age, percent non-Hispanic white, mean self-care score at admission) and structural characteristics (rural location, freestanding, for-profit ownership) explained variance only in self-care; facilities' case mix (mean patient age, percent non-Hispanic white, percent living with social support, mean mobility score at admission) explained variance in mobility. Community variables were nonsignificant.
  
  
  
  Individual and facility factors were significant predictors of discharge self-care and mobility among Medicare hip fracture patients in IRFs. The findings may improve quality of IRF services to hip fracture patients and inform risk adjustment methods.
authors.affiliation: Duke University School of Nursing, Durham, NC. Electronic address: michael.cary@duke.edu.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Cary
authors.affiliation: Duke University School of Nursing, Durham, NC.
authors.forename: Wei
authors.initials: W
authors.lastname: Pan
authors.affiliation: Center for the Study of Aging, School of Medicine, Duke University, Durham, NC.
authors.forename: Richard
authors.initials: R
authors.lastname: Sloane
authors.affiliation: Duke University School of Nursing, Durham, NC.
authors.forename: Janet Prvu
authors.initials: JP
authors.lastname: Bettger
authors.affiliation: Physical Medicine & Rehabilitation Service, Durham Veterans Affairs Medical Center, Durham, NC; Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC.
authors.forename: Helen
authors.initials: H
authors.lastname: Hoenig
authors.affiliation: Duke University School of Nursing, Durham, NC.
authors.forename: Elizabeth I
authors.initials: EI
authors.lastname: Merwin
authors.affiliation: Duke University School of Nursing, Durham, NC.
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Anderson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare; D055361:Multilevel Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data*; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012648:Self Care / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States; D016138:Walking
keywords: Health services research; Hip fractures; Medicare; Outcome assessment (health care); Rehabilitation; Rehabilitation centers
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