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

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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