Article

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.

Langue : ANGLAIS