The contribution of rehabilitation settings to the cost of integrated continuum-care episodes for hip fracture: a retrospective cohort study

Abstract

Background. Hip fracture (HF) requires an intensive healthcare resources utilization. Long-term morbidity related to poor fracture management is associated with a significant increase in healthcare costs. Many factors may affect the costs and outcomes in patients with HF. Using a definition of integrated Continuum-Care Episode (CCE) that encompasses the hospital phase and the post-acute rehabilitation after a surgical procedure for HF, we investigated the costs of CCEs for HF and their determinants, with particular regard to the contribution of different rehabilitation settings. Methods. We conducted a retrospective observational cohort study using data extracted from administrative databases of 5094 consecutive patients hospitalized for HF in 2017, aged ≥65 years, and resident in Emilia Romagna, Italy. To evaluate the overall costs of the CCE, we calculated the acute and post-acute costs from the date of the first hospital admission to the end of the integrated CCE. The determinants of costs were investigated using generalized linear regression models. Results. After adjusting for demographic and clinical characteristics, type of surgery (b=-0.340, p<0.001), and hospital bed-based rehabilitation in public or private healthcare facilities either followed by rehabilitation in a community hospital/temporary nursing home beds (b=0.372, p<0.001) or not (b=0.313, p<0.001) were the strongest determinants of costs, while rehabilitation in intermediate care facilities alone was associated with lower costs (0.163, p<0.001). Conclusions. Our findings suggest that CCE cost and its variability is mainly related to the rehabilitation settings. Cost-wise, intermediate care resulted to be an appropriate setting for providing post-acute rehabilitation for HF, representing the one associated with the lower cost of the overall CCE. Therefore, intermediate care settings should be privileged when planning HF rehabilitation pathways.