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Postacute Rehabilitation Care for Hip Fracture: Who Gets the Most Care?

Authors

  • Janet K. Freburger PT, PhD,

    Corresponding author
    1. Institute on Aging, University of North Carolina, Chapel Hill, North Carolina
    • Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
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  • George M. Holmes PhD,

    1. Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
    2. Department of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina
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  • Li-Jung E. Ku PhD, MPP

    1. Department of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina
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Address correspondence to Janet K. Freburger, Cecil G. Sheps Center for Health Services Research, 725 Martin Luther King, Jr. Blvd., University of North Carolina, Chapel Hill, NC 27599. E-mail: janet_freburger@unc.edu

Abstract

Objectives

To determine the extent to which demographic and geographic disparities exist in postacute rehabilitation care (PARC) use after hip fracture.

Design

Cross-sectional analysis of 2 years (2005–06) of population-based hospital discharge data.

Setting

All short-term acute care hospitals in four demographically and geographically diverse states (AZ, FL, NJ, WI).

Participants

Individuals aged 65 and older (mean 82.9) admitted to the hospital with a hip fracture who survived their inpatient stay (N = 64,065). The sample was 75.1% female and 91.5% white, 5.8% Hispanic, and 2.7% black.

Measurements

Whether the participant received institutional PARC; for participants who did not receive institutional care, whether they received home health (HH) care; and for participants who received institutional care, whether they received skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF) care. Multilevel logistic regression analyses were conducted to identify demographic and geographic disparities in PARC use.

Results

Considering PARC on a continuum from more to fewer hours of care per day (IRF→SNF→HH→no HH), minorities and individuals of lower socioeconomic status (SES) generally received a lower volume of care. Individuals on Medicaid or who were uninsured were less likely to receive institutional care (odds ratio (OR) = 0.23, 95% confidence interval (CI) = 0.18–0.30) and to receive HH (OR = 0.46, 95% CI = 0.30–0.70) and more likely to receive SNF than IRF care (OR = 2.03, 95% CI = 1.36–3.05). Hispanics were less likely to receive institutional care (OR = 0.70, 95% CI = 0.62–0.79), and Hispanics (OR = 1.31) and blacks (OR = 1.49) were more likely to receive SNF than IRF care. There were also geographic differences in PARC.

Conclusion

Several demographic and geographic disparities in PARC use were identified. Future research should confirm these findings and further elucidate factors that contribute to the observed disparities.

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