Article

OBJECTIVE: To examine contextual (facility and community) and individual factors
associated with self-care and mobility outcomes among Medicare hip fracture
patients receiving inpatient rehabilitation. DESIGN: Retrospective cohort study
of 3 linked data files: Inpatient Rehabilitation Facility-Patient Assessment
Instrument, Provider of Services, and Area Health Resources. Multilevel modeling
was used to examine the effects of contextual and individual factors on self-care
and mobility outcomes. SETTING: Inpatient rehabilitation facilities (IRFs).
PARTICIPANTS: Medicare hip fracture patients (N=35,264; mean age, 81y) treated in
IRFs (N=1072) in 2012. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES:
Self-care (eating, grooming, bathing, upper and lower body dressing, toileting)
and mobility (walk/wheelchair, stairs) at discharge. RESULTS: Mean +/- SD
self-care and mobility scores at admission were 3.17+/-.87 and 1.24+/-.51,
respectively; mean +/- SD self-care and mobility scores at discharge were
5.03+/-1.09 and 3.31+/-1.54, respectively. Individual and contextual levels
explained 44.4% and 21.6% of the variance in self-care at discharge,
respectively, and 19.5% and 1.9% of the variance in mobility at discharge,
respectively. At the individual level, age, race/ethnicity, cognitive and motor
FIM scores at admission, and tier comorbidities explained variance in self-care
and mobility; sex and length of stay explained variance only in self-care. At the
contextual level, facilities' case mix (mean patient age, percent non-Hispanic
white, mean self-care score at admission) and structural characteristics (rural
location, freestanding, for-profit ownership) explained variance only in
self-care; facilities' case mix (mean patient age, percent non-Hispanic white,
percent living with social support, mean mobility score at admission) explained
variance in mobility. Community variables were nonsignificant. CONCLUSIONS:
Individual and facility factors were significant predictors of discharge
self-care and mobility among Medicare hip fracture patients in IRFs. The findings
may improve quality of IRF services to hip fracture patients and inform risk
adjustment methods.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS