Variation in Functional Status After Hip Fracture: Facility and Regional Influence on Mobility and Self-Care

Overview

Journal J Gerontol A Biol Sci Med Sci

Specialty Geriatrics

Date 2017 Jan 6

PMID 28052981

Citations 3

Authors

Srinivas Teppala

Kenneth J Ottenbacher

Karl Eschbach

Amit Kumar

Soham Al Snih

Winston J Chan

Timothy A Reistetter

Affiliations

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Abstract

Background: Recent reports show substantial geographic variation in postacute health care spending. Little is known about variation in functional outcomes after postacute rehabilitation for patients with hip fracture. We examined variation in mobility and self-care after hip fracture rehabilitation across inpatient rehabilitation facilities (IRFs), hospital referral regions (HRRs) and states.

Methods: Retrospective cohort study using data from the Centers for Medicare and Medicaid Services (CMS) from 2006 to 2009. Study sample included 149,258 records from patients 66 years and older at 1,166 IRFs located within 292 HRRs and across 50 states. Hip fracture cases were defined by CMS impairment group codes (08.11, 08.12). Hierarchical generalized linear models were used to assess discharge mobility and self-care functional status, adjusting for individual patient characteristics and the random effect of IRFs, HRRs, and states.

Results: Variation in discharge mobility status as assessed by the intraclass correlation percentage (ICC%) was 8.8% across IRFs, 4.0% across HRRs, and 1.8% across states. For self-care, the ICCs were 10.2% across IRFs, 4.8% across HRRs, and 2.4% across states. The range of discharge mobility scores (maximum functional status rating to minimum functional status rating) showed a 9.6-point difference for IRFs, 6.5 for regions, and 2.6 for states. Range of discharge self-care scores were 13.1 for IRFs, 6.8 for HRRs, and 3.4 for states.

Conclusion: Variation in functional status following postacute hip fracture rehabilitation appears to occur primarily at the level of facilities rather than geographic location.

Citing Articles

Development and Evaluation of Rehabilitation Service Areas for the United States.

Reistetter T, Dean J, Haas A, Prochaska J, Jupiter D, Eschbach K BMC Health Serv Res. 2023; 23(1):204.

PMID: 36859285 PMC: 9976368. DOI: 10.1186/s12913-023-09184-2.

Understanding Variation in Postacute Care: Developing Rehabilitation Service Areas Through Geographic Mapping.

Reistetter T, Eschbach K, Prochaska J, Jupiter D, Hong I, Haas A Am J Phys Med Rehabil. 2020; 100(5):465-472.

PMID: 32858537 PMC: 8262929. DOI: 10.1097/PHM.0000000000001577.

Regional variation of care dependency after hip fracture in Germany: A retrospective cohort study using health insurance claims data.

Schulz C, Buchele G, Peter R, Rothenbacher D, Roigk P, Rapp K PLoS One. 2020; 15(3):e0230648.

PMID: 32203564 PMC: 7089542. DOI: 10.1371/journal.pone.0230648.

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