Project Summary
Hip fracture is significantly associated with functional impairment, high readmission rates, long-term
institutionalization, and mortality. Each year approximately 186,300 hip fracture patients are discharged from
hospitals to post-acute care settings for rehabilitation service. Due to prolonged immobilization, patients with
hip fractures are at a greater risk of developing medical deconditioning and frailty. Thus, timely rehabilitation
services (occupational therapy [OT] and physical therapy [PT]) are needed to maximize functional recovery
and facilitate successful discharge back into the community. Clinical practice guidelines post hip fracture
recommend timely evaluation and comprehensive rehabilitation services. However, there is limited national-
level information on the effectiveness of hospital-based rehabilitation services in patients with hip fracture. The
objectives of this proposal are to: 1) identify source of the hospital-level variation associated with the utilization
of hospital-based rehabilitation services after hip fracture and 2) examine the association between receipt of
hospital-based rehabilitation services with post-acute admission functional status, hospital readmission (30-
day/90-day), and home-to-home time (from hospital admission date to discharge to home including post-acute
stay).
This study will utilize the 100% Medicare claims data in the Standard Analytical File format and patient-level
assessment data from post-acute settings. This study will use a retrospective cohort design to examine
Medicare fee-for-service beneficiaries aged =66 years who were admitted to the hospital in 2016-2017 after hip
fracture. Measures for hospital-based rehabilitation services will be created by using the revenue center codes
for OT and PT services for evaluation and types of therapy. In order to examine the dose response effect of
therapy, the amount of rehabilitation services will be classified into no therapy, low, medium, and high therapy
categories. Multilevel regression models will be developed to estimate variation in OT and PT utilization that
are attributable to patient, hospital and regional factors. After that, separate multilevel linear and logistic
regression models will examine the relationship between utilization of rehabilitation services and functional
status and unplanned readmission respectively, after controlling for patient case-mix differences and hospital
characteristics, and accounting for post-acute discharge destination