Alison M. Cogan, PhD, OTR/L Polytrauma/TBI Advanced Fellow Washington DC VA Medical Center Alexandria, Virginia

After Hip Fracture Surgery, Length of Rehab Stay, Not Number of Treatments, Linked to Improved Self-Care Interview with:

Alison M. Cogan, PhD, OTR/L Polytrauma/TBI Advanced Fellow Washington DC VA Medical Center Alexandria, Virginia

Dr. Cogan

Alison MCoganPhDOTR/L
Polytrauma/TBI Advanced Fellow
Washington DC VA Medical Center
Washington DC What is the background for this study?

Response: Medicare is shifting from a volume- to value-based payment for postacute care services, in which value is determined by patient characteristics and functional outcomes. Matching therapy time and length of stay (LOS) to patient needs is critical to optimize functional outcomes and manage costs. The objective of this study was to investigate the association among therapy time, LOS, and functional outcomes for patients following hip fracture surgery.

This retrospective cohort study analyzed data on patients from 4 inpatient rehabilitation facilities and 7 skilled nursing facilities in the eastern and midwestern United States. Participants were patients aged 65 years or older who received inpatient rehabilitation services for hip fracture and had Medicare fee-for-service as their primary payer. We categorized patients into nine recovery groups based on low, medium, and high therapy minutes per day and low, medium, or high rate of functional gain per day. We measured the groups for functional mobility independence and self-care capabilities at the time each patient was discharged. What are the main findings?

 Response: Our main finding was that rate of recovery and LOS in skilled nursing and inpatient rehabilitation facilities were associated with mobility and self-care outcomes at discharge following hip fracture surgery; therapy minutes per day accounted for less than 1% of the variance in functional outcome. What should readers take away from your report?

Response: We often think that more therapy is better for patients, but that may not always be the case. If a patient undergoes surgery after experiencing hip fracture, tracking their rate of functional improvement early in the rehabilitation process may help with discharge planning. For example, the rehabilitation team can begin educating family members and/or caregivers about the kind of assistance with daily activities that the patient is likely to need after discharge earlier in the process. Rehabilitation teams may also recommend a longer inpatient stay with a less intensive therapy schedule for patients who are likely to need more time to recover. What recommendations do you have for future research as a result of this work?

Response: Our next steps are to replicate the study with a larger national sample and also to apply the same methodology to other questions for patients with other conditions requiring rehabilitation services, such as stroke and joint replacement.

Disclosures: Dr. Cogan receives support from a Polytrauma/TBI advanced fellowship funded by the Veterans Health Affairs Office of Academic Affiliations. The original study that enabled the collection of the data for the submitted work was funded by Department of Education, National Institute on Disability, and Rehabilitation Research and Training Center on Measuring Rehabilitation Outcomes and Effectiveness (award H133B040032) to Allen Heinemann, PhD, at the Rehabilitation Institute of Chicago (now the Shirley Ryan Ability Lab). Dr Mallinson was a coinvestigator on that original funding.



Cogan AM, Weaver JA, McHarg M, Leland NE, Davidson L, Mallinson T. Association of Length of Stay, Recovery Rate, and Therapy Time per Day With Functional Outcomes After Hip Fracture Surgery. JAMA Netw Open. 2020;3(1):e1919672. doi:10.1001/jamanetworkopen.2019.19672



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Last Updated on January 31, 2020 by Marie Benz MD FAAD