Abstract
BACKGROUND: Pneumonia is a common comorbidity among hospitalized older adults and may impede functional restoration and increase medical cost. Medicare reimbursement rates for patients receiving in-patient medical rehabilitation services are higher for individuals who have comorbid pneumonia. We examined the impact of comorbid pneumonia on outcomes for patients with lower extremity fracture receiving in-patient medical rehabilitation services.
METHODS: Secondary data analysis of medical records obtained from 919 in-patient rehabilitation facilities in the United States. The sample included 153,241 subjects who received in-patient rehabilitation services following lower extremity fracture in 2005–2007. We used multivariable linear regression to evaluate the independent effects of pneumonia on stay and discharge functional status (Functional Independence Measure instrument), and logistic regression models to explore discharge to home versus not home.
RESULTS: Pneumonia was a comorbidity for 4,265 (2.8%) of the subjects with lower extremity fracture. The multivariable models indicated that subjects with no payment-eligible comorbidity experienced shorter stay (regression coefficient −0.44, 95% CI −0.60 to −0.28 d), higher discharge functional status ratings (regression coefficient 1.84, 95% CI 1.42–2.25 points), and higher odds of home discharge (odds ratio 1.19, 95% CI 1.09–1.29), compared to subjects with pneumonia.
CONCLUSIONS: Our findings suggest that comorbid pneumonia is associated with poorer rehabilitation outcomes (stay, discharge functional status, and discharge setting) among subjects receiving in-patient rehabilitation services for lower extremity fracture.
Footnotes
- Correspondence: Kenneth J Ottenbacher PhD, Division of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston TX 77555-1137, E-mail: kottenba{at}utmb.edu.
Dr Ahmed presented a version of this paper at the Open Forum of the AARC Congress 2013, held November 5–8, 2013, in Tampa, Florida.
Dr Ottenbacher was partly supported by National Institutes of Health grant R01 HD6570201. The authors have disclosed no conflicts of interest.
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