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Relationship Between Acute Care Hospital-Based Factors and Discharge Destination for Rehabilitation Following a Hip Fracture

Published online by Cambridge University Press:  31 March 2010

Bert M. Chesworth ,
Mark Speechley ,
Kathleen Hartford  and
Richard Crilly
Bert M. Chesworth*
Affiliation:
Ontario Joint Replacement Registry, London Health Sciences Centre, London, ON.
Mark Speechley
Affiliation:
Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON.
Kathleen Hartford
Affiliation:
Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON. Lawson Health Research Institute, London Health Sciences Centre, London, ON.
Richard Crilly
Affiliation:
Division of Geriatric Medicine, University of Western Ontario, London, ON.
*
Requests, etc.: Bert M. Chesworth, Ph.D., Research Director and Senior Methodologist, Ontario Joint Replacement Registry, London Health Sciences Centre – University Campus, 339 Windermere Road, P.O. Box 5339, London, ON, Canada N6A 5A5
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Abstract

Hospitals may transfer seniors with a hip fracture to various rehabilitation settings. Knowing the relationship between hospital teaching status and post-acute rehabilitation setting may help evaluations of the transfer from acute care. The purpose of this study was to determine the relationship between hospital teaching status and rehabilitation destination following acute care in seniors with a hip fracture. Hospital separations were linked with home care records to identify hip fractures and hospital-based or home care rehabilitation (n = 806). Two logistic regression models determined the likelihood of transfer to any rehabilitation destination and to hospital-based versus home care rehabilitation. Teaching hospitals were no more likely than non-teaching hospitals to discharge patients to any rehabilitation (OR 1.20, 95% CI 0.88,1.65). However, among those referred to rehabilitation, the odds of discharge to hospital-based versus home care rehabilitation were almost four times greater for patients in teaching hospitals (OR 3.76, 95% CI 2.23, 6.37). The results are consistent with the availability of post-acute rehabilitation in the planning area. Future study of post-acute rehabilitation outcomes should consider hospital teaching status as an indicator of how hospital-based factors may affect the utilization of post-acute rehabilitation.

Résumé

Les hôpitaux peuvent acheminer les aîné(e)s ayant subi une fracture de la hanche vers différents programmes de réadaptation. Connaître l'existence de la relation entre le fait que l'hôpital soit un établissement d'enseignement et les installations de l'établissement de soins post-impératifs permet de mieux évaluer le retrait du patient des soins impératifs. L'étude visait à déterminer la relation entre le statut d'enseignement de l'hôpital et le choix du mode de réadaptation faisant suite à la période de soins impératifs accordés aux aîné(e)s ayant subi fracture de la hanche. On a comparé des dossiers de départs d'hôpitaux et ceux des soins à domicile et retenu ceux où les fractures de la hanche avaient été soignées à l'hôpital ou à la maison (n = 806). Deux modèles de régression logistique ont servi à déterminer l'éventualité d'un déplacement vers un centre de réadaptation ou un hôpital ou, par ailleurs, vers la prestation de soins en vertu d'un programme de réadaptation à la maison. Les hôpitaux d'enseignement n'étaient pas plus susceptibles que les hôpitaux ordinaires d'acheminer les patients vers un établissement de réadaptation (OR 1.20, 95% CI 0.88, 1.65). Cependant, parmi les patients admis en réadaptation, la moyenne de transition vers des soins à l'hôpital plutôt que vers des soins de réadaptation à la maison était quatre fois plus élevée chez les patients provenant d'hôpitaux d'enseignement (OR 3.76, 95% CI 2.23, 6.37). Les résultats sont conformes à la disponibilité des soins de réadaptation post-impératifs à l'étape de la planification. Les études éventuelles sur les programmes de soins de réadaptation post-impératifs devraient tenir compte du fait que l'hôpital soit un hôpital d'enseignement comme indicateur de l'influence des facteurs hospitaliers sur l'utilisation des soins de réadaptation post-impératifs.

Keywords

Hip FractureHospital Teaching StatusPost-Acute RehabilitationHome CareFracture de la hanchehôpital d'enseignementrééducation post-impérativesoins à domicile
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 21 , Issue 2 , Summer/Été 2002 , pp. 187 - 194
Copyright
Copyright © Canadian Association on Gerontology 2002

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Footnotes

*The authors thank (1) Paul Huras – Executive Director, and Stephanie Loomer – Epidemiologist, Thames Valley District Health Council, for their support of this project; and (2) Dr. Allan Donner – Chair, Department of Epidemiology and Biostatistics, University of Western Ontario, for his guidance on statistical matters.

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