Postacute Rehabilitation Care for Hip Fracture: Who Gets the Most Care?

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Abstract
Objectives: To determine the extent to which demographic and geographic disparities exist in postacute rehabilitation care ( PARC ) use after hip fracture. Design: Cross‐sectional analysis of 2 years (2005–06) of population‐based hospital discharge data. Setting: All short‐term acute care hospitals in four demographically and geographically diverse states ( AZ , FL , NJ , WI ). Participants: Individuals aged 65 and older (mean 82.9) admitted to the hospital with a hip fracture who survived their inpatient stay (N = 64,065). The sample was 75.1% female and 91.5% white, 5.8% Hispanic, and 2.7% black. Measurements: Whether the participant received institutional PARC ; for participants who did not receive institutional care, whether they received home health ( HH ) care; and for participants who received institutional care, whether they received skilled nursing facility ( SNF ) or inpatient rehabilitation facility ( IRF ) care. Multilevel logistic regression analyses were conducted to identify demographic and geographic disparities in PARC use. Results: Considering PARC on a continuum from more to fewer hours of care per day ( IRF → SNF → HH →no HH ), minorities and individuals of lower socioeconomic status ( SES ) generally received a lower volume of care. Individuals on Medicaid or who were uninsured were less likely to receive institutional care (odds ratio ( OR ) = 0.23, 95% confidence interval ( CI ) = 0.18–0.30) and to receive HH ( OR = 0.46, 95% CI = 0.30–0.70) and more likely to receive SNF than IRF care ( OR = 2.03, 95% CI = 1.36–3.05). Hispanics were less likely to receive institutional care ( OR = 0.70, 95% CI = 0.62–0.79), and Hispanics ( OR = 1.31) and blacks ( OR = 1.49) were more likely to receive SNF than IRF care. There were also geographic differences in PARC . Conclusion: Several demographic and geographic disparities in PARC use were identified. Future research should confirm these findings and further elucidate factors that contribute to the observed disparities.

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