Journal of Rehabilitation Research & Development (JRRD)

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Volume 50 Number 9, 2013
   Pages 1267 — 1276

Abstract — Determinants of postsurgical discharge setting for male hip fracture patients

Matthew L. Maciejewski, PhD;1–2* Tiffany A. Radcliff, PhD;3–5 William G. Henderson, PhD;3,5 Diane Cowper Ripley, PhD;6 W. Bruce Vogel, PhD;6 Elizabeth Regan, MD, PhD;5,7 Evelyn Hutt, MD3,5

1Center for Health Services Research in Primary Care, Durham Department of Veterans Affairs (VA) Medical Center, Durham, NC; 2Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC;
3University of Colorado Health Outcomes Program, Aurora, CO; 4Department of Health Policy and Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX; 5VA Eastern Colorado Healthcare System, Denver, CO; 6North Florida/South Georgia VA Health System, Gainesville, FL; 7National Jewish Health, Denver, CO

Abstract — 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.

Key words: admission, discharge, hip fracture, home care, inpatient rehabilitation, Medicare, nursing home, outpatient rehabilitation, treatment, veterans.

View HTML  ¦  View PDF  ¦  Contents Vol. 50, No. 9
This article and any supplementary material should be cited as follows:
Maciejewski ML, Radcliff TA, Henderson WG, Cowper Ripley D, Vogel WB, Regan E, Hutt E. Determinants of postsurgical discharge setting for male hip fracture patients. J Rehabil Res Dev. 2013;50(9):127–76.

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