Postacute rehabilitation care for hip fracture: Who gets the most care?

Janet K. Freburger, George M. Holmes, Li Jung E. Ku

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objectives To determine the extent to which demographic and geographic disparities exist in postacute rehabilitation care (PARC) use after hip fracture. Design Cross-sectional analysis of 2 years (2005-06) of population-based hospital discharge data. Setting All short-term acute care hospitals in four demographically and geographically diverse states (AZ, FL, NJ, WI). Participants Individuals aged 65 and older (mean 82.9) admitted to the hospital with a hip fracture who survived their inpatient stay (N = 64,065). The sample was 75.1% female and 91.5% white, 5.8% Hispanic, and 2.7% black. Measurements Whether the participant received institutional PARC; for participants who did not receive institutional care, whether they received home health (HH) care; and for participants who received institutional care, whether they received skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF) care. Multilevel logistic regression analyses were conducted to identify demographic and geographic disparities in PARC use. Results Considering PARC on a continuum from more to fewer hours of care per day (IRF→SNF→HH→no HH), minorities and individuals of lower socioeconomic status (SES) generally received a lower volume of care. Individuals on Medicaid or who were uninsured were less likely to receive institutional care (odds ratio (OR) = 0.23, 95% confidence interval (CI) = 0.18-0.30) and to receive HH (OR = 0.46, 95% CI = 0.30-0.70) and more likely to receive SNF than IRF care (OR = 2.03, 95% CI = 1.36-3.05). Hispanics were less likely to receive institutional care (OR = 0.70, 95% CI = 0.62-0.79), and Hispanics (OR = 1.31) and blacks (OR = 1.49) were more likely to receive SNF than IRF care. There were also geographic differences in PARC. Conclusion Several demographic and geographic disparities in PARC use were identified. Future research should confirm these findings and further elucidate factors that contribute to the observed disparities.

Original languageEnglish
Pages (from-to)1929-1935
Number of pages7
JournalJournal of the American Geriatrics Society
Volume60
Issue number10
DOIs
Publication statusPublished - 2012 Oct 1

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Subacute Care
Hip Fractures
Rehabilitation
Odds Ratio
Skilled Nursing Facilities
Inpatients
Hispanic Americans
Confidence Intervals
Demography
Minority Health
Medicaid
Home Care Services
Social Class
Cross-Sectional Studies
Logistic Models

All Science Journal Classification (ASJC) codes

  • Geriatrics and Gerontology

Cite this

Freburger, Janet K. ; Holmes, George M. ; Ku, Li Jung E. / Postacute rehabilitation care for hip fracture : Who gets the most care?. In: Journal of the American Geriatrics Society. 2012 ; Vol. 60, No. 10. pp. 1929-1935.
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title = "Postacute rehabilitation care for hip fracture: Who gets the most care?",
abstract = "Objectives To determine the extent to which demographic and geographic disparities exist in postacute rehabilitation care (PARC) use after hip fracture. Design Cross-sectional analysis of 2 years (2005-06) of population-based hospital discharge data. Setting All short-term acute care hospitals in four demographically and geographically diverse states (AZ, FL, NJ, WI). Participants Individuals aged 65 and older (mean 82.9) admitted to the hospital with a hip fracture who survived their inpatient stay (N = 64,065). The sample was 75.1{\%} female and 91.5{\%} white, 5.8{\%} Hispanic, and 2.7{\%} black. Measurements Whether the participant received institutional PARC; for participants who did not receive institutional care, whether they received home health (HH) care; and for participants who received institutional care, whether they received skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF) care. Multilevel logistic regression analyses were conducted to identify demographic and geographic disparities in PARC use. Results Considering PARC on a continuum from more to fewer hours of care per day (IRF→SNF→HH→no HH), minorities and individuals of lower socioeconomic status (SES) generally received a lower volume of care. Individuals on Medicaid or who were uninsured were less likely to receive institutional care (odds ratio (OR) = 0.23, 95{\%} confidence interval (CI) = 0.18-0.30) and to receive HH (OR = 0.46, 95{\%} CI = 0.30-0.70) and more likely to receive SNF than IRF care (OR = 2.03, 95{\%} CI = 1.36-3.05). Hispanics were less likely to receive institutional care (OR = 0.70, 95{\%} CI = 0.62-0.79), and Hispanics (OR = 1.31) and blacks (OR = 1.49) were more likely to receive SNF than IRF care. There were also geographic differences in PARC. Conclusion Several demographic and geographic disparities in PARC use were identified. Future research should confirm these findings and further elucidate factors that contribute to the observed disparities.",
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Postacute rehabilitation care for hip fracture : Who gets the most care? / Freburger, Janet K.; Holmes, George M.; Ku, Li Jung E.

In: Journal of the American Geriatrics Society, Vol. 60, No. 10, 01.10.2012, p. 1929-1935.

Research output: Contribution to journalArticle

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N2 - Objectives To determine the extent to which demographic and geographic disparities exist in postacute rehabilitation care (PARC) use after hip fracture. Design Cross-sectional analysis of 2 years (2005-06) of population-based hospital discharge data. Setting All short-term acute care hospitals in four demographically and geographically diverse states (AZ, FL, NJ, WI). Participants Individuals aged 65 and older (mean 82.9) admitted to the hospital with a hip fracture who survived their inpatient stay (N = 64,065). The sample was 75.1% female and 91.5% white, 5.8% Hispanic, and 2.7% black. Measurements Whether the participant received institutional PARC; for participants who did not receive institutional care, whether they received home health (HH) care; and for participants who received institutional care, whether they received skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF) care. Multilevel logistic regression analyses were conducted to identify demographic and geographic disparities in PARC use. Results Considering PARC on a continuum from more to fewer hours of care per day (IRF→SNF→HH→no HH), minorities and individuals of lower socioeconomic status (SES) generally received a lower volume of care. Individuals on Medicaid or who were uninsured were less likely to receive institutional care (odds ratio (OR) = 0.23, 95% confidence interval (CI) = 0.18-0.30) and to receive HH (OR = 0.46, 95% CI = 0.30-0.70) and more likely to receive SNF than IRF care (OR = 2.03, 95% CI = 1.36-3.05). Hispanics were less likely to receive institutional care (OR = 0.70, 95% CI = 0.62-0.79), and Hispanics (OR = 1.31) and blacks (OR = 1.49) were more likely to receive SNF than IRF care. There were also geographic differences in PARC. Conclusion Several demographic and geographic disparities in PARC use were identified. Future research should confirm these findings and further elucidate factors that contribute to the observed disparities.

AB - Objectives To determine the extent to which demographic and geographic disparities exist in postacute rehabilitation care (PARC) use after hip fracture. Design Cross-sectional analysis of 2 years (2005-06) of population-based hospital discharge data. Setting All short-term acute care hospitals in four demographically and geographically diverse states (AZ, FL, NJ, WI). Participants Individuals aged 65 and older (mean 82.9) admitted to the hospital with a hip fracture who survived their inpatient stay (N = 64,065). The sample was 75.1% female and 91.5% white, 5.8% Hispanic, and 2.7% black. Measurements Whether the participant received institutional PARC; for participants who did not receive institutional care, whether they received home health (HH) care; and for participants who received institutional care, whether they received skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF) care. Multilevel logistic regression analyses were conducted to identify demographic and geographic disparities in PARC use. Results Considering PARC on a continuum from more to fewer hours of care per day (IRF→SNF→HH→no HH), minorities and individuals of lower socioeconomic status (SES) generally received a lower volume of care. Individuals on Medicaid or who were uninsured were less likely to receive institutional care (odds ratio (OR) = 0.23, 95% confidence interval (CI) = 0.18-0.30) and to receive HH (OR = 0.46, 95% CI = 0.30-0.70) and more likely to receive SNF than IRF care (OR = 2.03, 95% CI = 1.36-3.05). Hispanics were less likely to receive institutional care (OR = 0.70, 95% CI = 0.62-0.79), and Hispanics (OR = 1.31) and blacks (OR = 1.49) were more likely to receive SNF than IRF care. There were also geographic differences in PARC. Conclusion Several demographic and geographic disparities in PARC use were identified. Future research should confirm these findings and further elucidate factors that contribute to the observed disparities.

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