Functional status and readmissions in unilateral hip fractures

Am J Manag Care. 2015 Apr 1;21(4):e282-7.


Objectives: To test whether functional status is a robust predictor of acute care readmission risk in patients who have been discharged to an inpatient rehabilitation facility (IRF) following a unilateral hip fracture.

Study design: Retrospective database study using a large administrative data set.

Methods: A retrospective analysis of data from the Uniform Data System for Medical Rehabilitation from the years 2002 to 2011 was performed, examining patients with an impairment of unilateral hip fracture. A basic prediction model based on functional status was compared with competing models incorporating medical comorbidities. C statistics were compared to evaluate model performance.

Results: There were a total of 433,154 patients: 32,783 (7.87%) patients were transferred back to an acute hospital, including 7937 (1.91%) transferred within 3 days, 16,150 (3.88%) transferred within 7 days, and 32,607 (7.83%) transferred within 30 days after IRF admission. The C statistics for the Basic Model are 0.710, 0.674, and 0.667 at days 3, 7, and 30, respectively. Compared with the Basic Model, the best performing Basic-Plus model was the Basic+Elixhauser Model with C statistic differences of +0.013, +0.014, and +0.019, and the best performing Age-Comorbidity Model was the Age+Elixhauser Model with C statistic differences of -0.110, -0.079, and -0.065 at days 3, 7, and 30, respectively.

Conclusions: Functional status is a robust and potentially modifiable risk factor for patients admitted to IRFs following a unilateral hip fracture.

MeSH terms

  • Comorbidity
  • Disability Evaluation*
  • Female
  • Hip Fractures / rehabilitation*
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Patient Discharge / statistics & numerical data*
  • Patient Readmission / statistics & numerical data*
  • Patient Transfer / statistics & numerical data
  • Rehabilitation Centers / statistics & numerical data*
  • Retrospective Studies
  • Risk Factors