Inpatient Rehabilitation Outcomes in Medicare Hip Fracture Patients

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DESCRIPTION (provided by applicant): To date, policy directives based on anecdotal reports, drive utilization and treatment decisions. Although hip fracture is considered by Center for Medicare and Medicaid Services (CMS) as a medically appropriate diagnosis for Inpatient Rehabilitation Facility (IRF) care, little evidence is available to support this assumption. Building on sparse existing evidence, the overall objective of this project is to determine which client and system characteristics result in improved rehabilitation outcomes. An analytic file using two large national datasets, the CMS Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) and the Provider of Service (POS) file, will be constructed to test regression models of factors that may explain differences in rehabilitation outcomes between two time points, admission and discharge from IRFs. Using the Andersen's Model for Health Services Use as the conceptual framework, the proposed longitudinal study aims to: (1) determine the influence of individual characteristics (Predisposing: age, gender, race), (Enabling: social support), (Need: functional status and cognitive status on admission, and comorbidities) on rehabilitation outcomes (motor functioning, functional status and discharged home) for Medicare beneficiaries with hip fracture in IRFs; and (2) determine the influence of contextual characteristics (type, size, location, ownership and nurse staffing) on IRF aggregate rehabilitation outcomes (motor functioning, functional status, and discharge home), controlling for the influence of aggregate individual characteristics (Predisposing, Enabling and Need) of Medicare beneficiaries with hip fracture in IRFs. This study will inform the policy debate on which types of patients are most appropriate for IRFs and will determine the effectiveness of IRFs in delivering rehabilitative treatment based on specific individual and contextual characteristics associated with rehabilitative outcomes among hip fracture patients and vulnerable subgroups (i.e., racial/ethnic minorities, older adults without adequate social support and those 85 years and older). Of particular concern is determining the evidence base to indicate that such effectiveness will result in positive outcomes among racial/ethnic minorities. Given the growing national interest in health disparities, it becomes increasingly important to determine if there are differences in outcomes based on race/ethnicity. Health disparities remain a major research focus of the National Institute of Nursing Research (NINR). The proposed research and subsequent analysis will add to the current body of nursing knowledge by identifying characteristics that better inform interventions that look to eliminate racial/ethnic disparities.