Posthospital setting, resource utilization, and self-care outcome in older women with hip fracture

Objective: To compare posthospital rehabilitation resource utilization and self-care outcome of women with hip fracture discharged to three types of setting (home, inpatient rehabilitation, skilled nursing). Design: Prospective cohort study. Patient interviews in the hospital, 2 and 6 months after fracture; hospital record reviews. Setting: Two general community and two teaching hospitals. Patients: Consecutive sample of community-living women with hip fracture, aged 65 and over. Of 179 eligible, 130 patients enrolled and 123 completed study. Interventions: Prospective observational study. Main Outcome Measures: Posthospital institutional days, cumulative sessions of physical and occupational therapy within 6 months after fracture, and 2- and 6-month Barthel Index. Results: For patients discharged to home, inpatient rehabilitation, and skilled nursing, respectively, mean posthospital institutional days were 1, 16, and 50; mean sessions of physical therapy were 15, 35, and 50; mean sessions of occupational therapy were 0, 11, and 16; mean 2-month Barthel Index was 93, 89, and 80; mean 6-month Barthel Index was 89, 88, and 86. Differences in posthospital institutional days and physical and occupational therapy sessions, but not 2- and 6-month Barthel Index, were statistically significant after controlling for patient characteristics. Conclusions: Type of posthospital setting is associated with resource utilization, but not self-care outcome after hip fracture. (C) 1997 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.