Hospital-Based Rehabilitation Services in Older Adults After Hip Fracture and Impact on Health Outcomes

项目摘要 髋部骨折与功能障碍、高再入院率、长期 制度化和死亡率。每年约有186，300名髋部骨折患者出院， 医院到急症后护理机构提供康复服务。由于长期固定， 髋部骨折有更大的风险发展为医学失调和虚弱。因此，及时康复 需要服务（职业治疗[OT]和物理治疗[PT]）以最大限度地恢复功能 并帮助他们顺利出院重返社区。髋部骨折后临床实践指南 建议及时评估和全面的康复服务。然而，国家的有限- 一级信息的有效性医院为基础的康复服务的髋部骨折患者。的 本提案的目标是：1）确定与利用率相关的医院级差异的来源 的医院为基础的康复服务后，髋部骨折和2）检查之间的关联， 以医院为基础的康复服务与急性入院后的功能状态，再入院（30- 天/90天）和回家时间（从入院日期到出院回家，包括急性期后 stay）。 本研究将使用标准分析文件格式和患者水平的100% Medicare索赔数据 急性后环境的评估数据。本研究将采用回顾性队列设计， 2016-2017年因髋关节置换术后入院的年龄≥66岁的医疗保险按服务收费受益人 骨折将使用收入中心代码创建基于医院的康复服务措施 用于OT和PT服务的评估和治疗类型。为了检查剂量反应效应， 治疗，康复服务量将分为无治疗，低，中，高治疗 类别将开发多水平回归模型，以估计OT和PT利用率的变化， 是由病人、医院和地区因素造成的。然后，将多水平线性和logistic 回归模型将研究康复服务的利用与功能之间的关系， 在控制患者病例组合差异和医院后， 特征，并说明急性后出院目的地

Project Summary Hip fracture is significantly associated with functional impairment, high readmission rates, long-term institutionalization, and mortality. Each year approximately 186,300 hip fracture patients are discharged from hospitals to post-acute care settings for rehabilitation service. Due to prolonged immobilization, patients with hip fractures are at a greater risk of developing medical deconditioning and frailty. Thus, timely rehabilitation services (occupational therapy [OT] and physical therapy [PT]) are needed to maximize functional recovery and facilitate successful discharge back into the community. Clinical practice guidelines post hip fracture recommend timely evaluation and comprehensive rehabilitation services. However, there is limited national- level information on the effectiveness of hospital-based rehabilitation services in patients with hip fracture. The objectives of this proposal are to: 1) identify source of the hospital-level variation associated with the utilization of hospital-based rehabilitation services after hip fracture and 2) examine the association between receipt of hospital-based rehabilitation services with post-acute admission functional status, hospital readmission (30- day/90-day), and home-to-home time (from hospital admission date to discharge to home including post-acute stay). This study will utilize the 100% Medicare claims data in the Standard Analytical File format and patient-level assessment data from post-acute settings. This study will use a retrospective cohort design to examine Medicare fee-for-service beneficiaries aged ≥66 years who were admitted to the hospital in 2016-2017 after hip fracture. Measures for hospital-based rehabilitation services will be created by using the revenue center codes for OT and PT services for evaluation and types of therapy. In order to examine the dose response effect of therapy, the amount of rehabilitation services will be classified into no therapy, low, medium, and high therapy categories. Multilevel regression models will be developed to estimate variation in OT and PT utilization that are attributable to patient, hospital and regional factors. After that, separate multilevel linear and logistic regression models will examine the relationship between utilization of rehabilitation services and functional status and unplanned readmission respectively, after controlling for patient case-mix differences and hospital characteristics, and accounting for post-acute discharge destination