Does standardized rehabilitation and discharge planning improve functional recovery in elderly patients with hip fracture?

Objective: To determine whether standardized early rehabilitation and discharge planning increase risk-adjusted function and reduce risk-adjusted institutionalization in the first 6 months after hip fracture. Design: Pre-post study of 2 independent population-based inception cohorts. Setting: Two tertiary hospitals in an urban health region. Participants: Patients with hip fracture (N=919) 65 years and older. Intervention: Subjects were enrolled before (control) and after (intervention) implementation of standardized rehabilitation and discharge planning. Main Outcome Measures: Function and institutionalization status were assessed at time of fracture and 3 and 6 months postfracture. Administrative databases provided length of stay (LOS) data. Results: After risk-adjustment, the Barthel Index score was significantly lower 3 months postfracture in control patients with low social support compared with those with higher social support (P <.05). Social support did not affect 3-month function in the intervention cohort. Control subjects with low social support were also significantly more likely to reside in long-term care by 6 months postfracture than intervention subjects with similar social support or those with higher social support (odds ratio = 3.3; 95% confidence interval, 1.4-7.5). Total LOS did not change between cohorts. Conclusions: Overall, standardized rehabilitation and discharge planning did not affect postoperative function or institutionalization in elderly patients with hip fracture. In intervention patients with low social support, function improved and institutionalization was reduced.