Comparison of Medical Outcomes and Utilization for Hip Fracture Patients with and without Physical Therapy: A Retrospective Cohort Study

• Main Authors: Pin-Hsun Lin, 林品薰
• Other Authors: Tzuo-Yun Lan
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/11420577967213147955

碩士 === 國立陽明大學 === 醫務管理研究所 === 104 === Background: Although there are many studies about the effect of rehabilitation on hip fracture patients, most of them only focus on the outcomes such as re-fracture, functional recovery, and death, and relatively few on medical utilization. In addition, National Health Insurance (NHI) in Taiwan has not yet covered the post-acute care services that have been integrated in the continuity care in many countries, and only provides outpatient rehabilitation services after discharge for hip fracture patients. Therefore, this provides an opportunity to examine whether such a different type of care also improves the outcomes and reduces the medical utilization for hip fracture patients. The purpose of this study was to compare the medical outcomes and utilization in hip fracture patients receiving or no receiving outpatient rehabilitation. Methods: The study was designed as a retrospective cohort study. Data were obtained from one million people drawn in 2005 from the National Health Insurance Research Database (NHIRD). All patients aged 65 years and over who were admitted for hip fracture between 1 January 2005 and 31 December 2012 were included. Hip fracture cases were defined as having the diagnosis of hip fracture (ICD-9-CM codes 820.XX), and surgery (codes of 64028C, 64029B, 64030B, 64170B, 64162B, 64041C, 95005C and 95017C). All included patients were divided into two groups based on whether or not the outpatient rehabilitation was given during the first three months after hospital discharge. The propensity score matching analysis matched by gender, age, Charlson Comorbidity Index (CCI) and Adjusted Clinical Groups (ACG) with the 1:4 matching ratio was employed. In total, 3,585 subjects with hip fracture were enrolled in the study and 717 subjects received outpatient physical therapy while 2,868 subjects did not. Each hip fracture patient was followed for one year after hip fracture for selected outcomes and medical utilization. The outcomes included death, emergency use, and re-hospitalization. Medical utilization included total costs, outpatient costs (including emergency), emergency costs, other outpatient costs (excluded emergency and rehabilitation), and inpatient costs. Statistical analysis included the comparison of descriptive and multivariate statistical analysis between two groups. For multivariate statistical analysis, Cox proportional hazards regression model was used for outcomes and Generalized Linear Model was used for medical utilization analysis respectively. Results: Patients receiving the outpatient rehabilitation during the first three months after hospital discharge demonstrated significantly lower mortality rate than those without rehabilitation (12.69% vs. 16.70%, p<0.05). And more benefical effect was observed for those receiving continuous rehabilitation, with the mortality rates of 13.15%, 11.56% and 8.48% for the first, second and third month following rehabilitation. After adjustment, rehabilitation group had statistically significant lower risk of death (HR=0.74；95% CI：0.59-0.94). However, patients receiving rehabilitation were at higher risk of emergency (HR=1.15；95% CI：1.02-1.30) and re-hospitalization (HR=1.37；95% CI：1.22-1.55). After adjusting for covariates, rehabilitation group had higher medical utilization including total costs, outpatient costs, other outpatient costs, and inpatient costs (all p<0.05). Conclusion: Patients receiving rehabilitation have lower risk of death, but higher risk of emergency and re-hospitalization as compared with those without rehabilitation. In medical utilization, the rehabilitation group has higher total costs, outpatient costs, other outpatient costs, and inpatient costs than those without rehabilitation.