Use of Rehabilitation and Other Health Care Services by Patients With Joint Replacement After Discharge From Skilled Nursing and Inpatient Rehabilitation Facilities

• Published in: Archives of physical medicine and rehabilitation Vol. 90; no. 8; pp. 1297 - 1305
• Main Authors: DeJong, Gerben, PhD, Tian, Wenqiang, MD, PhD, Smout, Randall J., MS, Horn, Susan D., PhD, Putman, Koen, PhD, Smith, Pamela, DNs, RN, Gassaway, Julie, MS, RN, DaVanzo, Joan E., PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2009; Elsevier
• Subjects: Aged; Arthroplasty, replacement, hip; Arthroplasty, Replacement, Hip - rehabilitation; Arthroplasty, replacement, knee; Arthroplasty, Replacement, Knee - rehabilitation; Biological and medical sciences; Diseases of the osteoarticular system; Female; Health Services - utilization; Hospital readmission; Humans; Interviews as Topic; Male; Medical sciences; Miscellaneous; Orthopedic surgery; Patient Discharge; Physical Medicine and Rehabilitation; Postoperative Complications - therapy; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Rehabilitation; Rehabilitation centers; Rehabilitation Centers - utilization; Skilled nursing facilities; Skilled Nursing Facilities - utilization; Subacute Care - utilization; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; United States; Utilization; United States; Health Maintenance Organization; PT; Hospital readmission; SNF; emergency room; Comprehensive Severity Index; CSI; Joint Replacement Outcomes in Inpatient Rehabilitation Facilities and Nursing Treatment Sites; inpatient rehabilitation facility; BMI; Arthroplasty, replacement, knee; Arthroplasty, replacement, hip; OT; body mass index; CMS; Rehabilitation centers; follow-up study to Joint Replacement Outcomes in Inpatient Rehabilitation Facilities and Nursing Treatment Sites; HMO; skilled nursing facility; ER; Skilled nursing facilities; LOS; Utilization; JOINTS I; length of stay; physical therapy; Rehabilitation; IRF; JOINTS II; Center for Medicare and Medicaid Services; occupational therapy; Knee; Human; Prosthesis; Health care staff; Health service; Arthroplasty; Hip; Care; Reeducation; Rehospitalization; Orthopedics; replacement; Nurse
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2008.12.029

Abstract DeJong G, Tian W, Smout RJ, Horn SD, Putman K, Smith P, Gassaway J, DaVanzo JE. Use of rehabilitation and other health care services by patients with joint replacement after discharge from skilled nursing and inpatient rehabilitation facilities. Objective To compare use of rehabilitation and other health services among patients with knee and hip replacement after discharge from a skilled nursing facility (SNF) or an inpatient rehabilitation facility (IRF). Design Follow-up interview study at 7.5 months after discharge. Setting Five freestanding SNFs, 1 hospital-based SNF, and 6 IRFs from across the United States. Participants Patients (N=856): patients with knee replacement (n=561) and patients with hip replacement (n=295). Interventions No interventions. Main Outcome Measures Number of home and outpatient therapy visits, physician visits, emergency room visits, rehospitalizations, and medical complications. Results After discharge from postacute care, the vast majority of patients received home rehabilitation, outpatient rehabilitation, or both. Patients with knee replacement received an average of 19 home and/or outpatient rehabilitation visits; patients with hip replacement received almost 15 visits. There were no statistically significant differences in rates of emergency room use and rehospitalization except that patients with hip replacement discharged from IRFs had higher rates of rehospitalization than those discharged from freestanding SNFs (15.8% vs 3.1%). Multivariate analyses did not find any SNF/IRF effects. Conclusions Patients with joint replacement from both SNFs and IRFs receive considerable amounts of follow-up rehabilitation care. Study uncovered no setting effects related to rehospitalization or medical complications. Looking only at care rendered in the initial postacute setting provides an incomplete picture of all care received and how it may affect follow-up outcomes.