Differences in Outcome: Hospital Rehabilitation vs Skilled Nursing Facility Rehabilitation

Abstract

To the Editor.— Analysis of data gathered on the hip fracture population at Spaulding Rehabilitation Hospital, Boston, Mass, contrasts with some of the findings illustrated in the study titled The Impact of Prospective Payment Systems on the Treatment of Hip Fractures in the Elderly by Palmer et al.1 Spaulding Rehabilitation Hospital data does suggest that despite Prospective Payment Systems and pressure to reduce lengths of stay, Spaulding was able to achieve outcome. Since the implementation of Prospective Payment Systems, Spaulding, like St Vincent's, has been able to achieve the same, and, in some cases, better results within a shorter hospitalization. By increasing the intensity of the treatment programs and encouraging staff and patients to achieve specific targeted goals, quality outcome can be achieved. However, the failure of treatments in two studies from Indianapolis by Palmer et al,1and Fitzgerald et al2is alarming and contrasts sharply