Ching-Yi Wang1, James E Graham2, Amol M Karmarkar3, Timothy A Reistetter4, Elizabeth J Protas5, Kenneth J Ottenbacher6. 1. School of Physical Therapy and Center for Education and Research on Geriatrics and Gerontology, Chung Shan Medical University, Taichung, Taiwan(∗). 2. Division of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-1137(†). Electronic address: jegraham@utmb.edu. 3. Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX(‡). 4. Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX(§). 5. School of Health Professions, University of Texas Medical Branch, Galveston, TX(‖). 6. Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX(¶).
Abstract
OBJECTIVE: To assess the utility of functional status in classifying patients by discharge setting after inpatient rehabilitation for hip fracture. DESIGN: Retrospective cohort study. SETTING: A total of 1257 inpatient rehabilitation facilities in the United States. PATIENTS: Medicare beneficiaries (N = 117,168) receiving inpatient rehabilitation for hip fracture from 2007 to 2009. METHODS: Receiver operating characteristic curve analyses to assess the overall discriminatory ability of functional status scores (Functional Independence Measure [FIM] total, FIM cognition, and FIM motor) and to identify the functioning threshold that best differentiates patients by discharge setting. MAIN OUTCOME MEASUREMENTS: Discharge setting (community versus institutional). RESULTS: Approximately 68% of patients were discharged to the community after inpatient rehabilitation for hip fracture. Receiver operating characteristic curve analyses indicate that discharge FIM motor ratings (area under the curve: 0.84) alone are as effective as a multivariable model (area under the curve: 0.85), including sociodemographic and clinical factors, in discriminating patients discharged to the community from those discharged to an institution. A discharge FIM motor rating of 58 yielded the best balance in sensitivity and specificity for classifying patients by discharge setting. CONCLUSIONS: Discharge FIM motor ratings demonstrated good discriminatory ability for classifying discharge setting. An FIM motor rating of 58 may serve as a clinical tool to guide treatment plans and/or as additional information in complex discharge planning decisions for patients with hip fracture.
OBJECTIVE: To assess the utility of functional status in classifying patients by discharge setting after inpatient rehabilitation for hip fracture. DESIGN: Retrospective cohort study. SETTING: A total of 1257 inpatient rehabilitation facilities in the United States. PATIENTS: Medicare beneficiaries (N = 117,168) receiving inpatient rehabilitation for hip fracture from 2007 to 2009. METHODS: Receiver operating characteristic curve analyses to assess the overall discriminatory ability of functional status scores (Functional Independence Measure [FIM] total, FIM cognition, and FIM motor) and to identify the functioning threshold that best differentiates patients by discharge setting. MAIN OUTCOME MEASUREMENTS: Discharge setting (community versus institutional). RESULTS: Approximately 68% of patients were discharged to the community after inpatient rehabilitation for hip fracture. Receiver operating characteristic curve analyses indicate that discharge FIM motor ratings (area under the curve: 0.84) alone are as effective as a multivariable model (area under the curve: 0.85), including sociodemographic and clinical factors, in discriminating patients discharged to the community from those discharged to an institution. A discharge FIM motor rating of 58 yielded the best balance in sensitivity and specificity for classifying patients by discharge setting. CONCLUSIONS: Discharge FIM motor ratings demonstrated good discriminatory ability for classifying discharge setting. An FIM motor rating of 58 may serve as a clinical tool to guide treatment plans and/or as additional information in complex discharge planning decisions for patients with hip fracture.
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