Benefits of home health care after inpatient rehabilitation for hip fracture: health service use by Medicare beneficiaries, 1987-1992.

OBJECTIVE

To examine the added benefit of home health services for elderly patients with hip fracture discharged home after inpatient rehabilitation.

DATA

Medicare claims from 1% of 1986 beneficiaries followed until 1992.

STUDY POPULATION

Persons hospitalized with hip fracture at 70 years or older who had no major Medicare claims during the year before hospitalization and who were discharged home after inpatient rehabilitation.

OUTCOMES

Rehospitalization and any nonskilled nursing facility (non-SNF) nursing home admission during the 12 months after hospital discharge.

RESULTS

Patients who received additional home health services (27.2%) were less likely to be hospitalized than those who received rehabilitation only (31.1%); they were also less likely to have a non-SNF nursing home admission (11.3% vs 23.3%), and more likely to survive the year with no subsequent Medicare claims (65.6% vs 55%). Propensity scores were used to adjust for nonrandom treatment selection in a Cox proportional hazards analysis showing that home health was associated with a significantly lower risk of nursing home admission (adjusted odds ratio = .42, 95% confidence interval .21-.84), and hospitalization (adjusted odds ratio = .65, 95% confidence interval .26-1.00).

CONCLUSIONS

Studies of the relative effectiveness of post-acute services and postdischarge evaluations of inpatient rehabilitation should consider additional home care as a postacute service and examine optimal postacute treatment to minimize additional service use.