Discharge setting for patients with hip fracture: Trends from 2001 to 2005

OBJECTIVES: To examine recent trends in discharge disposition after hospitalization for hip fracture. DESIGN: Retrospective observational study using data from the 5% random sample of Medicare claims data from 2001 to 2005 that the Centers for Medicare and Medicaid Services makes available for research purposes. SETTING: Inpatient medical rehabilitation pre- and postimplementation of prospective payment (2001-2005). PARTICIPANTS: Forty-four thousand six hundred eighty-four Medicare patients. MEASURES: Postacute discharge setting (home, inpatient rehabilitation, skilled nursing facility, and long-term care nursing home/hospital/hospice). RESULTS: Bivariate analyses showed that discharge from acute care to inpatient rehabilitation increased from 12.2% in 2001 to 23.9% in 2005. The odds of discharge to inpatient medical rehabilitation were 2.26 (95% confidence interval=2.09-2.45) greater in 2005 than in 2001 after adjustment for patient characteristics (age, sex, and race or ethnicity), admitting diagnoses, type of treatment (internal fixation vs arthroplasty), and length of stay. CONCLUSION: The move from fee for service to prospective payment for postacute services for persons with hip fracture was associated with greater use of inpatient medical rehabilitation. Further research is necessary to confirm the trend in discharge setting and determine whether it is related to changes in reimbursement for postacute care.