Patterns of rehabilitation utilization after hip fracture in acute hospitals and skilled nursing facilities

BACKGROUND. Hospitalized hip fracture patients may receive physical therapy (PT) in acute and/or postacute settings. Patterns of PT use may vary by pa tient, clinical, and hospital characteristics. These patterns can be analyz ed if the acute and postacute stays are linked. OBJECTIVES. We classified the following patterns of PT use: acute PT only, skilled nursing facility (SNF) PT only, acute and SNF PT, and no PT. For ea ch pattern, we compared (1) characteristics of hip fracture patients, (2) l ength of stay (LOS), and (3) discharge outcomes. SUBJECTS. The study included 187,990 hospitalized hip fracture patients der ived from Medicare administrative data. MEASURES. Dependent variables were PT use patterns, acute hospital and SNF LOS, total episode days of care, and discharge destination. Independent var iables were demographic, clinical, and facility characteristics. PT use pat terns were also used as independent variables in the LOS and discharge dest ination models. RESULTS. Patterns of PT use were influenced by demographic and clinical cha racteristics such as age, race, and surgery type. Similarly, different LOS measures and discharge destinations varied by the PT use patterns. Patients receiving acute PT had longer acute LOSs; however, those patients who were subsequently transferred to SNFs had shorter SNF LOSs and total episode da ys of care. Patients utilizing PT were more likely to be discharged to home after the acute or SNF stay. CONCLUSIONS. Disparities in PT use exist for subgroups of patients such as the elderly and blacks. Providers should determine the most appropriate set ting for initiation of PT to achieve better discharge outcomes with efficie nt use of resources.