Koval K J, Aharonoff G B, Su E T, Zuckerman J D
Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York City, NY 10003, USA.
J Bone Joint Surg Am. 1998 Mar;80(3):357-64. doi: 10.2106/00004623-199803000-00008.
A study was performed to assess the impact of intensive inpatient rehabilitation on the outcome after a fracture of the femoral neck or an intertrochanteric fracture. Before 1990, our hospital did not have an inpatient rehabilitation program. On January 1, 1990, a diagnosis-related-group-exempt (DRG-exempt) acute rehabilitation program was initiated. Patients were discharged to this program after evaluation by a staff physiatrist. Before 1990, twenty-seven (9.0 per cent) of 301 patients were discharged to an outside rehabilitation facility. After January 1990, the percentage of patients who were discharged to the DRG-exempt program increased yearly, from nineteen (17 per cent) of 113 patients in 1990 to forty-one (64 per cent) of sixty-four patients in 1993; this difference was significant (p < 0.01). Before 1990, the average duration of the stay in the hospital was 21.9 days. After January 1990, the average duration for the patients who did not enter the rehabilitation program was 20.0 days whereas the average duration for those who did was 31.4 days (16.1 days for acute care and 15.6 days for the rehabilitation program). There were no differences in the hospital discharge status or in the walking ability, place of residence, need for home assistance, or independence in basic and instrumental activities of daily living at the six and twelve-month follow-up examinations between patients who had been managed before initiation of the rehabilitation program and those managed after it or between patients who had been discharged to this program after its initiation and those who had not. These results raise serious questions regarding the global cost-effectiveness of these programs for patients who have had a fracture of the femoral neck or an intertrochanteric fracture.
开展了一项研究，以评估强化住院康复对股骨颈骨折或转子间骨折后预后的影响。1990年前，我院没有住院康复项目。1990年1月1日，启动了一项诊断相关组豁免（DRG豁免）急性康复项目。患者经专职物理治疗师评估后转入该项目。1990年前，301例患者中有27例（9.0%）出院后转入外部康复机构。1990年1月以后，转入DRG豁免项目的患者比例逐年增加，从1990年113例患者中的19例（17%）增至1993年64例患者中的41例（64%）；这一差异具有统计学意义（p<0.01）。1990年前，平均住院时间为21.9天。1990年1月以后，未进入康复项目的患者平均住院时间为20.0天，而进入康复项目的患者平均住院时间为31.4天（急性护理16.1天，康复项目15.6天）。在康复项目启动前接受治疗的患者与启动后接受治疗的患者之间，或康复项目启动后转入该项目的患者与未转入该项目的患者之间，在出院时的状况、行走能力、居住地点、家庭护理需求以及在6个月和12个月随访时的基本日常生活活动和工具性日常生活活动独立性方面均无差异。这些结果对这些项目用于股骨颈骨折或转子间骨折患者的总体成本效益提出了严重质疑。
