An Examination of the First 30 Days After Patients are Discharged to the Community From Hip Fracture Postacute Care

Abstract

Background Post-acute care (PAC) rehabilitation aims to maximize independence and facilitate a safe community transition. Yet little is known about PAC patients’ success in staying home post-discharge or differences on this outcome across PAC providers. Objectives Examine the percentage of PAC patients who remain in the community at least 30 days after discharge (i.e., successful community discharge) following hip fracture rehabilitation and describe differences among PAC facilities based on this outcome. Research Design Retrospective observational study. Subjects Community-dwelling, Medicare fee-for-service beneficiaries 75 years of age and older who experienced their first hip fracture between 1999–2007 (n=880,779). PAC facilities admitting hip fracture patients in 2006. Measures Successful community discharge, sites of readmission after PAC discharge. Results Between 1999 and 2007, 57% of patients achieved successful community discharge. Black were less likely (adjusted odds ratios=0.84, 95% confidence interval 0.82–0.86) than similar whites to achieve successful community discharge. Among all who re-entered the community (n=581,095), 14% remained in the community fewer than 30 days. Acute hospitals (67.5%) and institutional PAC (16.8%) were the most common sites of re-entry. The median proportion of successful community discharge among facilities was 49% (IQR: 33%–66%). Lowest-quartile facilities admitted older (85.9 vs. 84.1 years of age), sicker patients (e.g., higher rates of hospital complications 6.0% vs. 4.6%), but admitted fewer annually (7.1 vs. 19.3), compared to the highest quartile. Conclusions Re-entry into the healthcare system after PAC community discharge is common. Due to the distinct care needs of the PAC population there is a need for a quality measure that complements the current 30-day hospital readmission outcome and captures the objectives of PAC rehabilitation.

Successful Community Discharge Following Postacute Rehabilitation for Medicare Beneficiaries: Analysis of a Patient‐Centered Quality Measure

“…Our results are consistent with previous findings that older age predicts higher risk of unsuccessful community discharge among patients receiving postacute rehabilitation (Leland et al. ). This study also revealed a gender disparity: Men were less likely to experience a successful community discharge.…”

“…Identifying PAC facility and regional‐level covariates (Leland et al. ; Reistetter et al. ), which might also account for differences in postacute outcomes, is also needed to inform future risk adjustment and warrants further investigation.…”

Rehabilitation Practitioners' Prioritized Care Processes in Hip Fracture Post-Acute Care

“…This renders rehabilitation providers ill-equipped to methodically enhance patient outcomes or engage in systematic quality improvement initiatives. With rehabilitation being an integral part of a patient's recovery process and PAC being the driver of raising healthcare costs, there is a need to classify what comprises high-quality care and its association to outcomes to enable rehabilitation to thrive in the healthcare reform framework (Leland et al, 2015; MaCurdy et al, 2013). …”

“…Specifically, patients experiencing a hip fracture have an increased risk of mortality, morbidity, hospital readmissions due to failed community transitions, and long-term institutionalization (Klop et al, 2016; Leland et al, 2015; Haleem et al, 2008; Parker et al, 2006; Berry et al, 2008; Haentjiens et al, 2003; Lyles et al, 2008; van Helden et al, 2007). Furthermore, this patient population has a high risk of additional falls and fractures, which often result in subsequent hospital readmissions, institutionalization, and functional decline (Ryg et al, 2009; Huntjens et al, 2010).…”

“…Rather than returning home and receiving home health care or being transferred to an inpatient rehabilitation facility, a majority of these patients receive PAC in a skilled nursing facility (Leland et al, 2015; Nguyen-Oghalai et al, 2008). Unfortunately, adverse outcomes that include falls with injury and readmissions are prevalent in this patient population, thereby increasing the patient's risk of morbidity, mortality, and institutionalization, thereby limiting the possibility of achieving desired outcomes (Leland et al, 2015). …”