Disparity in Health Services and Outcomes for Persons With Hip Fracture and Lower Extremity Joint Replacement

Abstract

Disparity in outcomes appeared to be related to family structure and social support.

Racial disparities in knee and hip total joint arthroplasty: an 18-year analysis of national medicare data

“…It is possible that African–Americans experience more inhospital complications and, thus, have longer hospital LOS and are more likely to require admission to rehabilitation facilities after hospital discharge. Alternatively, it is possible that the longer LOS reflects patient preference while lower probability of being discharged home reflects reduced social support for African–Americans when compared with Caucasians,63 64 65 or lower rates of functional improvement during and after hospitalisation in African–Americans compared with Caucasians 66. Further research is needed to address these issues.…”

Outcomes and Reimbursement of Inpatient Rehabilitation Facilities and Subacute Rehabilitation Programs for Medicare Beneficiaries With Hip Fracture

“…Covariates that have been shown to influence outcomes and included in regression models were: the time from the fracture to the rehabilitation admission, admission motor FIM rating, 22 admission cognitive FIM rating, 23,24 type of hip fracture repair (hip replacement or open/closed reduction with/without internal fixation), 25 presence of a tier 1, tier 2, or tier 3 comorbidity, 26 age, 2 prehospital living arrangement (alone or not alone), 27 median household income (assigned based on residential ZIP code), 28 sex, 29 race (white or nonwhite), 30 number of patients with hip fracture treated in the facility (ie, volume), 31 county managed care penetration percent (from the Area Resource File), 32,33 rural location, 34 facility profit status (profit or not-for-profit), facility type (facility in a hospital or freestanding facility), 26 and geographic location (New England, Middle Atlantic, East North Central, West North Central, South Atlantic, East South Central, West South Central, Mountain or Pacific). 8 The outcomes models were estimated with and without LOS adjustment (transformed by its logarithm) to estimate the extent to which the observed outcomes may be related to LOS differences.…”

Inpatient Rehabilitation Outcomes in a National Sample of Medicare Beneficiaries With Hip Fracture

“…Compared to SNFs, IRFs show promise for improving functional outcomes of hip fracture patients after shorter lengths of stay (LOS), but their costs are much higher (Deutsch et al, 2005; Herbold, Bonistall, & Walsh, 2011; Munin et al, 2005). Available evidence on characteristics of hip fracture patients who are most likely to benefit from IRF rehabilitation is based either on national data collected before enforcement of the 60% rule (Graham, Chang, Bergés, Granger, & Ottenbacher, 2008; Munin et al, 2005; Ottenbacher et al, 2003) or on local studies limited to single facilities (Herbold et al, 2011; Semel, Gray, Ahn, Nasr, & Chen, 2010). Building on previous research (Graham et al, 2008; Ottenbacher et al, 2003), this study contributes to the literature because it is, to our knowledge, the first to use the CMS Inpatient Rehabilitation Facility-Patient Assessment Instrument [IRF-PAI] dataset to examine relationships between multiple patient characteristics and rehabilitation outcomes in a national sample of Medicare beneficiaries with hip fractures who were admitted to IRFs for post-acute rehabilitation.…”

“…Available evidence on characteristics of hip fracture patients who are most likely to benefit from IRF rehabilitation is based either on national data collected before enforcement of the 60% rule (Graham, Chang, Bergés, Granger, & Ottenbacher, 2008; Munin et al, 2005; Ottenbacher et al, 2003) or on local studies limited to single facilities (Herbold et al, 2011; Semel, Gray, Ahn, Nasr, & Chen, 2010). Building on previous research (Graham et al, 2008; Ottenbacher et al, 2003), this study contributes to the literature because it is, to our knowledge, the first to use the CMS Inpatient Rehabilitation Facility-Patient Assessment Instrument [IRF-PAI] dataset to examine relationships between multiple patient characteristics and rehabilitation outcomes in a national sample of Medicare beneficiaries with hip fractures who were admitted to IRFs for post-acute rehabilitation. Andersen’s Model for Health Services Use (Andersen, 2008) was used as a framework (Figure 1) for assessing individual characteristics known to influence rehabilitation outcomes in IRF patients (Ahmed, Graham, Karmarkar, Granger, & Ottenbacher, 2013; Deutsch et al, 2005; Graham et al, 2008; Herbold et al, 2011; Munin et al, 2005; Nguyen-Oghalai, Ottenbacher, Granger, Smith, & Goodwin, 2006; Ottenbacher et al, 2003; Reistetter et al, 2011).…”

“…Building on previous research (Graham et al, 2008; Ottenbacher et al, 2003), this study contributes to the literature because it is, to our knowledge, the first to use the CMS Inpatient Rehabilitation Facility-Patient Assessment Instrument [IRF-PAI] dataset to examine relationships between multiple patient characteristics and rehabilitation outcomes in a national sample of Medicare beneficiaries with hip fractures who were admitted to IRFs for post-acute rehabilitation. Andersen’s Model for Health Services Use (Andersen, 2008) was used as a framework (Figure 1) for assessing individual characteristics known to influence rehabilitation outcomes in IRF patients (Ahmed, Graham, Karmarkar, Granger, & Ottenbacher, 2013; Deutsch et al, 2005; Graham et al, 2008; Herbold et al, 2011; Munin et al, 2005; Nguyen-Oghalai, Ottenbacher, Granger, Smith, & Goodwin, 2006; Ottenbacher et al, 2003; Reistetter et al, 2011). These included age, race, and gender (predisposing factors); social support (an enabling factor); functional status on admission, number of comorbidities, and tier comorbidities (need-related factors); and use of IRF services (a health behavior factor), operationalized as length of stay (LOS).…”