Functional status and readmissions in unilateral hip fractures

• Published in: The American journal of managed care Vol. 21; no. 4; pp. e282 - e287
• Main Authors: Gerrard, Paul, Goldstein, Richard, DiVita, Margaret A, Slocum, Chloe, Ryan, Colleen M, Mix, Jacqueline, Niewczyk, Paulette, Kazis, Lewis, Zafonte, Ross, Schneider, Jeffrey C
• Format: Journal Article
• Language: English
• Published: United States MultiMedia Healthcare Inc 01-04-2015
• Subjects: Comorbidity; Disability Evaluation; Female; Fractures; Health administration; Hip Fractures - rehabilitation; Hip joint; Humans; Length of Stay - statistics & numerical data; Male; Patient Discharge - statistics & numerical data; Patient Readmission - statistics & numerical data; Patient Transfer - statistics & numerical data; Rehabilitation; Rehabilitation Centers - statistics & numerical data; Retrospective Studies; Risk Factors
• ISSN: 1088-0224; 1936-2692

To test whether functional status is a robust predictor of acute care readmission risk in patients who have been discharged to an inpatient rehabilitation facility (IRF) following a unilateral hip fracture.
Retrospective database study using a large administrative data set.
A retrospective analysis of data from the Uniform Data System for Medical Rehabilitation from the years 2002 to 2011 was performed, examining patients with an impairment of unilateral hip fracture. A basic prediction model based on functional status was compared with competing models incorporating medical comorbidities. C statistics were compared to evaluate model performance.
There were a total of 433,154 patients: 32,783 (7.87%) patients were transferred back to an acute hospital, including 7937 (1.91%) transferred within 3 days, 16,150 (3.88%) transferred within 7 days, and 32,607 (7.83%) transferred within 30 days after IRF admission. The C statistics for the Basic Model are 0.710, 0.674, and 0.667 at days 3, 7, and 30, respectively. Compared with the Basic Model, the best performing Basic-Plus model was the Basic+Elixhauser Model with C statistic differences of +0.013, +0.014, and +0.019, and the best performing Age-Comorbidity Model was the Age+Elixhauser Model with C statistic differences of -0.110, -0.079, and -0.065 at days 3, 7, and 30, respectively.
Functional status is a robust and potentially modifiable risk factor for patients admitted to IRFs following a unilateral hip fracture.