Variations in Nursing Home Discharge Rates for Urban and Rural Nursing Facility Residents With Hip Fracture

Abstract

The finding of lower discharge rates among rural nursing facility residents appears to be consistent with previous studies demonstrating higher rates of nursing home use among rural residents. There continues to be a need for a better understanding of the role that service supply and accessibility and other factors play in the patterns and outcomes of rural long-term care.

Rehabilitation of Older Adults with Dementia After Hip Fracture

“…Individuals receiving surgery in rural hospitals had lower use of IPR than those in urban settings and higher rates of LTC admission, which has also been found in other studies . Although proximity to rehabilitation hospitals may influence access to IPR, HCR is available to the majority of individuals in Ontario.…”

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.…”

Measuring Rural Hospital Quality

“…The availability of other types of institutions, such as nursing homes, may be a determinant of different patterns of hospital use in rural areas than in urban areas. 17,18 The implication is that rural hospital quality is influenced by contextual issues that are addressed both by broad public policy and hospital action and by the ability of a rural hospital to adapt to its local context, organizing scarce resources in the best manner possible. The implications for quality measurement are the following:…”