REHABILITATION AND FUNCTION RECOVERY AFTER HIP FRACTURE

描述：(改编自研究者的摘要)这项建议的广泛、长期目标是了解急性后康复的效果，并改善老年髋部骨折患者的功能独立性。具体目标是：(1)对急性后康复设施的使用模式进行流行病学研究，以及与患者选择接受处方的急性后康复的康复地点相关的因素；(2)研究与急性后康复对功能恢复的短期和长期影响相关的因素。将测试急性后康复量对功能评分的剂量反应效应，以调整患者特征和其他潜在的共同创建者；(3)检查急性和急性后护理环境中因髋部骨折而产生的医疗保险付款的相关因素，并计算成本-效果比。髋部骨折是65岁及以上老年人的主要问题，会导致严重的死亡率、发病率和功能障碍。功能独立性的丧失给个人和照顾者带来了沉重的负担，并需要昂贵的长期护理。康复作为一种三级预防，旨在恢复骨折前的自主性和功能独立性。以前的研究检查了老年髋部骨折患者的功能恢复情况，这些患者大多在住院康复环境中接受干预。很少有研究考察急性康复后在多种环境(住院、门诊或亚急性康复环境)下对功能结果的影响，并考虑到康复服务的强度和数量。这项拟议的研究将采用纵向队列设计，前瞻性地收集和分析急性康复后对功能结果和成本的人口统计学、医学和心理社会影响。受试者将是300名患有单侧髋部骨折的社区老年人的样本，他们接受过手术修复(内固定、半关节置换或全髋关节置换)，并在任何一家预定的住院、门诊或亚急性康复机构接受了规定的急性康复。有关人口、医疗、心理社会特征和功能状况的纵向数据将通过反复访谈调查和联邦医疗保险索赔数据收集。这项研究的目的是提供有关急性康复后环境的选择和利用的流行病学数据，以及关于急性后康复对功能恢复的有效性和所产生的成本的信息。研究结果将有助于制定干预计划，以提高老年髋部骨折患者的功能独立性。

DESCRIPTION: (adapted from Investigator's abstract) The broad, long-term objectives of this proposal are to understand the effects of post-acute rehabilitation and to improve functional independence among older hip fracture patients. The specific aims are: (1) To conduct an epidemiologic study of the pattern of use of post-acute rehabilitation facilities and the factors associated with choice of rehabilitation locations where patients receive their prescribed post-acute rehabilitation; (2) To examine the factors associated with the short-term and long-term effect of post-acute rehabilitation on functional recovery. The dose response effect of the amount of post acute rehabilitation on functional score will be tested adjusting for patient characteristics and other potential cofounders; (3) To examine the factors associated with Medicare payment incurred due to hip fracture in both the acute and post- acute care setting and to calculate the cost-effectiveness ratio. Hip fracture, a major problem of persons ages 65 and over, causes significant mortality, morbidity, and functional impairment. The loss of functional independence imposes a heavy burden on individuals, caregivers, and requires costly long-term care. Rehabilitation, as a tertiary prevention, is intended to restore prefracture autonomy and functional independence. Previous studies have examined functional recovery among elderly hip fracture patients' who received interventions mostly in inpatient rehabilitation settings. Few studies have examined the effectiveness of post acute rehabilitation on functional outcome in multiple settings (inpatient, outpatient or subacute rehabilitation settings) and take into account the intensity and quantity of rehabilitation services received. The proposed study will use a longitudinal cohort design prospectively to collect and analyze demographic, medical, and psychosocial impacts of post acute rehabilitation on functional outcome and cost. Subjects will be a sample of 300 community- dwelling elders with unilateral hip fracture, who have had a surgical repair (internal fixation, hemiarthroplasty, or total hip replacement), and received prescribed post acute rehabilitations in any one of the predetermined inpatient, outpatient, or subacute rehabilitation facilities. The longitudinal data on demographic, medical, psychosocial characteristics and functional status will be collected through repeated interview surveys and Medicare claims data. The intent is that the results of this study will provide epidemiologic data on choice and utilization of post acute rehabilitation settings, and information on the effectiveness of post acute rehabilitation on functional recovery and cost incurred. Findings will be useful for developing intervention programs to improve functional independence among elderly hip fracture patients.