OUTCOMES AND COSTS AFTER HIP FRACTURE AND STROKE - A COMPARISON OF REHABILITATION SETTINGS

Objective.-To assess whether outcomes and costs differ for elderly pat ients admitted to rehabilitation hospitals, subacute nursing homes, an d traditional nursing homes. Design.-Inception cohort stratified by pr ovider type and followed prospectively for 6 months. Setting.-A total of 92 hospital-based units and freestanding facilities from 17 states. Patients.-A total of 518 randomly selected patients with hip fracture and 485 stroke patients admitted from November 1991 to February 1994. Main Outcome Measures.-At 6 months comparing community residence, rec overy to premorbid levels in 5 activities of daily living (ADLs), Medi care costs, and the number of therapy and physician visits. Outcomes w ere adjusted for premorbid residence and function, caregiver availabil ity, comorbid illness, admission function, cognition, depression, sens ory deficits, and mobility impairments. Results.-On admission, rehabil itation hospital patients were more likely (P<.001) to have caregivers and better cognitive and physical function. Hip fracture patients adm itted to rehabilitation hospitals did not differ from patients admitte d to nursing homes in returning to the community (adjusted odds ratio [OR], 1.3; 95% confidence interval [Cl], 0.6-2.6) or in the number of ADLs recovered to premorbid level (difference, 0.09 ADL; 95% Cl, -0.27 -0.44), but stroke patients admitted to rehabilitation hospitals were more likely to return to the community (adjusted OR, 3.3; 95% Cl, 1.5- 7.2) and recover ADLs (difference, 0.63 ADL; 95% CI, 0.201.07). Subacu te nursing home patients with stroke were more likely than traditional nursing home patients to return to the community (adjusted OR, 6.8; 9 5% Cl, 2.2-21 .4), there was no difference in return to the community for patients with hip fracture (adjusted OR, 1.6; 95% Cl, 0.7-3.6), an d there were no differences in recovery of ADLs for either condition. Medicare costs were greater (P<.001) for rehabilitation hospital patie nts than for subacute nursing home patients, and the costs for subacut e nursing home patients were greater (P=.03 for stroke and .009 for hi p fracture) than for traditional nursing home patients. Conclusions.-S tudy findings are consistent with enhanced outcomes for elderly patien ts with stroke treated in rehabilitation hospitals but not for patient s with hip fracture. Subacute nursing homes were more effective than t raditional nursing homes in returning patients with stroke to the comm unity, despite comparable functional outcomes.