A Comparative Evaluation of Inpatient Rehabilitation for Older Adults With Debility, Hip Fracture, and Myopathy

Abstract

Kortebein P, Granger CV, Sullivan DH. A comparative evaluation of inpatient rehabilitation for older adults with debility, hip fracture, and myopathy. Objective To compare the functional outcomes and discharge location of older adults admitted to inpatient rehabilitation for debility, hip fracture, and myopathy. Design Retrospective cohort study from 2002 to 2003 with information from the Uniform Data System for Medical Rehabilitation (UDSMR). Setting United States inpatient rehabilitation facilities subscribing to the UDSMR. Participants Patients 65 years or older (N=84.701) with primary diagnoses of debility (n=14,835), hip fracture (n=68,915), and myopathy (n=951). Interventions Not applicable. Main Outcome Measures Change in functional status, including efficiency (change in functional status divided by length of stay in days) and discharge setting. Results The efficiency of the patients with debility (1.7±2.1) was significantly lower than that of the patients with hip fracture (1.9±1.6; P<.001), but not different from the patients with myopathy (1.6±1.4; P=.3). Significantly more patients with debility (68%) were discharged home than the hip fracture and myopathy groups (66% and 65%, respectively; P<.001). Conclusions Although statistical differences exist, the functional recovery and rate of discharge home of older adult patients admitted to inpatient rehabilitation with a primary debility diagnosis are essentially the same clinically as those of patients with a diagnosis of either hip fracture or myopathy. Given these findings, and given that hip fracture and myopathy are approved medical conditions according to the Centers for Medicare and Medicaid Services 75% rule, the medical condition debility warrants consideration for inclusion as a qualifying medical diagnosis under this rule. However, further research is needed to develop relatively objective criteria for the debility diagnosis, and to identify those patients with debility who are most likely to benefit from inpatient rehabilitation.