Benefits of home health care after inpatient rehabilitation for hip fracture: Health service use by Medicare beneficiaries, 1987-1992

Objective: To examine the added benefit of home health services for elderly patients with hip fracture discharged home after inpatient rehabilitation. Data: Medicare claims from 1% of 1986 beneficiaries followed until 1992. Study Population: Persons hospitalized with hip fracture at 70 years or older who had no major Medicare claims during the year before hospitalization and who were discharged home after inpatient rehabilitation. Outcomes: Rehospitalization and any nonskilled nursing facility (non-SNF) nursing home admission during the 12 months after hospital discharge. Results: Patients who received additional home health services (27.2%) were less likely to be hospitalized than those who received rehabilitation only (31.1%); they were also less likely to have a non-SNF nursing home admission (11.3% vs 23.3%), and more likely to survive the year with no subsequent Medicare claims (65.6% vs 55%). Propensity scores were used to adjust for nonrandom treatment selection in a Cox proportional hazards analysis showing that home health was associated with a significantly lower risk of nursing home admission (adjusted odds ratio =.42, 95% confidence interval .21-.84), and hospitalization (adjusted odds ratio =.65, 95% confidence interval .26-1.00). Conclusions: Studies of the relative effectiveness of postacute services and postdischarge evaluations of inpatient rehabilitation should consider additional home care as a postacute service and examine optimal postacute treatment to minimize additional service use. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.