Medicine

ObjectiveTo determine the impact of osteoarthritis (OA) on length of rehabilitation stay, Functional Independence Measure (FIM Instrument) ratings at discharge and followup, functional gain, and percentage of patients discharged home.To determine the impact of osteoarthritis (OA) on length of rehabilitation stay, Functional Independence Measure (FIM Instrument) ratings at discharge and followup, functional gain, and percentage of patients discharged home.MethodsWe conducted a retrospective cohort analysis using a national registry of US medical rehabilitation inpatients. We obtained standardized data for all patients admitted after a hip fracture between 1994 and 2001. Our primary analytical method was multiple regression analysis. Outcome variables were length of stay, FIM Instrument ratings at discharge and followup, functional gain, and percentage of patients discharged home. The predictor variable was the presence of OA. Covariates were age, sex, race/ethnicity, other comorbidity, admission FIM ratings, total hip replacement, and time to followup.We conducted a retrospective cohort analysis using a national registry of US medical rehabilitation inpatients. We obtained standardized data for all patients admitted after a hip fracture between 1994 and 2001. Our primary analytical method was multiple regression analysis. Outcome variables were length of stay, FIM Instrument ratings at discharge and followup, functional gain, and percentage of patients discharged home. The predictor variable was the presence of OA. Covariates were age, sex, race/ethnicity, other comorbidity, admission FIM ratings, total hip replacement, and time to followup.ResultsWe studied 1,953 patients with OA and 11,441 patients without OA admitted to inpatient rehabilitation facilities after hip fracture. Mean ± SD length of stay for patients with OA was 18.1 ± 10.0 days versus 16.5 ± 8.9 days for those without OA (P < 0.01). After adjusting for age, sex, race/ethnicity, comorbidity, admission FIM ratings, and total hip replacement, OA was associated with a longer rehabilitation stay (1.4 days; P < 0.01) and slightly higher discharge FIM ratings; however, OA was not associated with lower weekly rehabilitation gain, followup FIM ratings, and percentage discharged home.We studied 1,953 patients with OA and 11,441 patients without OA admitted to inpatient rehabilitation facilities after hip fracture. Mean ± SD length of stay for patients with OA was 18.1 ± 10.0 days versus 16.5 ± 8.9 days for those without OA (P < 0.01). After adjusting for age, sex, race/ethnicity, comorbidity, admission FIM ratings, and total hip replacement, OA was associated with a longer rehabilitation stay (1.4 days; P < 0.01) and slightly higher discharge FIM ratings; however, OA was not associated with lower weekly rehabilitation gain, followup FIM ratings, and percentage discharged home.ConclusionPersons with hip fracture and OA had longer inpatient rehabilitation length of stay than persons without OA, but there were similarities in weekly rehabilitation gain and percentage discharged home.Persons with hip fracture and OA had longer inpatient rehabilitation length of stay than persons without OA, but there were similarities in weekly rehabilitation gain and percentage discharged home.

ObjectiveTo compare outcomes following stroke rehabilitation among patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) versus patients with neither RA nor SLE (non-RA/SLE).To compare outcomes following stroke rehabilitation among patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) versus patients with neither RA nor SLE (non-RA/SLE).MethodsWe conducted a retrospective analysis using a national database of patients with stroke admitted to inpatient rehabilitation between 1994 and 2001. Primary outcomes were discharge disposition and functional status, rated by the Functional Independence Measure (FIM) Instrument, at discharge and at followup. The independent variable was RA or SLE. Covariates were age, sex, race/ethnicity, admission FIM ratings, additional comorbidities (none, 1–3, and >3), type of stroke, and length of stay.We conducted a retrospective analysis using a national database of patients with stroke admitted to inpatient rehabilitation between 1994 and 2001. Primary outcomes were discharge disposition and functional status, rated by the Functional Independence Measure (FIM) Instrument, at discharge and at followup. The independent variable was RA or SLE. Covariates were age, sex, race/ethnicity, admission FIM ratings, additional comorbidities (none, 1–3, and >3), type of stroke, and length of stay.ResultsWe studied 47,853 patients with stroke, 368 with RA, and 119 with SLE. Discharge dispositions were similar for patients with RA and non-RA/SLE (81% discharged home). At discharge, the average FIM rating for patients with RA was 85.8, compared with 87.8 for non-RA/SLE patients. At followup, the average FIM rating for patients with RA was 95.9, compared with 99.6 for non-RA/SLE patients. RA was associated with lower FIM ratings at discharge and followup in multivariate analyses. SLE was associated with younger age (17.5 years). However, patients with SLE had similar discharge dispositions and FIM ratings to non-RA/SLE patients.We studied 47,853 patients with stroke, 368 with RA, and 119 with SLE. Discharge dispositions were similar for patients with RA and non-RA/SLE (81% discharged home). At discharge, the average FIM rating for patients with RA was 85.8, compared with 87.8 for non-RA/SLE patients. At followup, the average FIM rating for patients with RA was 95.9, compared with 99.6 for non-RA/SLE patients. RA was associated with lower FIM ratings at discharge and followup in multivariate analyses. SLE was associated with younger age (17.5 years). However, patients with SLE had similar discharge dispositions and FIM ratings to non-RA/SLE patients.ConclusionRA was associated with lower functional status ratings at discharge and followup. Outpatient therapy for patients with RA may reduce long-term assistance. Patients with SLE were younger, but had similar functional outcomes to patients without RA/SLE, suggesting early morbidity from stroke among patients with SLE.RA was associated with lower functional status ratings at discharge and followup. Outpatient therapy for patients with RA may reduce long-term assistance. Patients with SLE were younger, but had similar functional outcomes to patients without RA/SLE, suggesting early morbidity from stroke among patients with SLE.

OBJECTIVES: To determine the effect of neighborhood ethnic composition on power wheelchair prescriptions.DESIGN: The 5% noncancer sample of Medicare recipients in the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database, from 1994 to 2001.SETTING: SEER regions.PARTICIPANTS: Individuals covered by Medicare living in SEER regions without a cancer diagnosis.MEASUREMENTS: Individual characteristics (age, sex, ethnicity, justifying diagnosis, and comorbidity), primary diagnoses, neighborhood characteristics (percentage black, percentage Hispanic, percentage with <12 years education, and median income), and SEER region.RESULTS: The rate of power wheelchair prescriptions was 33 times greater in 2001 than in 1994, with a shift over time from justifying diagnoses more closely tied to mobility impairment, such as strokes, to less-specific medical diagnoses, such as osteoarthritis. In multilevel, multivariate analyses, individuals living in neighborhoods with higher percentages of blacks or Hispanics were more likely to receive power wheelchairs (odds ratios=1.09 for each 10% increase in black residents and 1.23 for each 10% increase in Hispanic residents) after controlling for ethnicity and other characteristics at the individual level.CONCLUSION: These results support allegations that marketers promoting power wheelchairs have specifically targeted minority neighborhoods.

ObjectiveTo determine if functional gain for patients following stroke rehabilitation is adversely affected by osteoarthritis (OA).To determine if functional gain for patients following stroke rehabilitation is adversely affected by osteoarthritis (OA).MethodsA retrospective cohort analysis was conducted using data collected between 1994 and 2001 from a large national registry of US rehabilitation inpatients. Outcome variables were functional status (the Functional Independence Measure [FIM Instrument]) at discharge and followup, FIM gain during and after rehabilitation, length of stay, and discharge setting. The primary predictor variable was the presence of OA. Covariates were age, sex, race, other comorbidities, type of stroke, length of stay, and time to followup. Analysis was by multivariable regression.A retrospective cohort analysis was conducted using data collected between 1994 and 2001 from a large national registry of US rehabilitation inpatients. Outcome variables were functional status (the Functional Independence Measure [FIM Instrument]) at discharge and followup, FIM gain during and after rehabilitation, length of stay, and discharge setting. The primary predictor variable was the presence of OA. Covariates were age, sex, race, other comorbidities, type of stroke, length of stay, and time to followup. Analysis was by multivariable regression.ResultsData from 3,094 patients with OA and 44,943 patients without OA admitted following a stroke to inpatient rehabilitation facilities were analyzed. In unadjusted analyses, OA was associated with significantly higher FIM ratings than patients without OA at admission (mean ± SD 65.7 ± 19.2 versus 63.1 ± 20.5; P < 0.001) and discharge (mean ± SD 89.2 ± 21.8 versus 87.7 ± 23.0; P < 0.001), but with lower FIM ratings at followup (mean ± SD 97.7 ± 24.7 versus 99.7 ± 24.9; P < 0.001). In multivariate analyses, adjusting for potential confounders, OA was associated with a 1.62-day increase in length of stay (95% confidence interval [95% CI] 1.15, 2.08) and a 1.37 smaller improvement in FIM scores between admission and followup (95% CI 0.62, 2.12). This smaller increase in FIM instrument score was caused by less improvement in FIM after discharge.Data from 3,094 patients with OA and 44,943 patients without OA admitted following a stroke to inpatient rehabilitation facilities were analyzed. In unadjusted analyses, OA was associated with significantly higher FIM ratings than patients without OA at admission (mean ± SD 65.7 ± 19.2 versus 63.1 ± 20.5; P < 0.001) and discharge (mean ± SD 89.2 ± 21.8 versus 87.7 ± 23.0; P < 0.001), but with lower FIM ratings at followup (mean ± SD 97.7 ± 24.7 versus 99.7 ± 24.9; P < 0.001). In multivariate analyses, adjusting for potential confounders, OA was associated with a 1.62-day increase in length of stay (95% confidence interval [95% CI] 1.15, 2.08) and a 1.37 smaller improvement in FIM scores between admission and followup (95% CI 0.62, 2.12). This smaller increase in FIM instrument score was caused by less improvement in FIM after discharge.ConclusionOA impairs recovery from stroke. This is compensated for by longer length of stay for inpatient medical rehabilitation. Reimbursement systems may need to consider the impact of OA as a comorbid condition in patients receiving stroke rehabilitation.OA impairs recovery from stroke. This is compensated for by longer length of stay for inpatient medical rehabilitation. Reimbursement systems may need to consider the impact of OA as a comorbid condition in patients receiving stroke rehabilitation.

Colorectal (CRC) cancer is the second leading cause of cancer deaths in the United States. Screening for CRC is widely recommended because of compelling evidence that it reduces incidence of and death from CRC. 1-6 It remains underused, however, even in populations having insurance and access to care.

OBJECTIVES: To examine recent trends in discharge disposition after hospitalization for hip fracture.DESIGN: Retrospective observational study using data from the 5% random sample of Medicare claims data from 2001 to 2005 that the Centers for Medicare and Medicaid Services makes available for research purposes.SETTING: Inpatient medical rehabilitation pre- and postimplementation of prospective payment (2001–2005).PARTICIPANTS: Forty-four thousand six hundred eighty-four Medicare patients.MEASURES: Postacute discharge setting (home, inpatient rehabilitation, skilled nursing facility, and long-term care nursing home/hospital/hospice).RESULTS: Bivariate analyses showed that discharge from acute care to inpatient rehabilitation increased from 12.2% in 2001 to 23.9% in 2005. The odds of discharge to inpatient medical rehabilitation were 2.26 (95% confidence interval=2.09–2.45) greater in 2005 than in 2001 after adjustment for patient characteristics (age, sex, and race or ethnicity), admitting diagnoses, type of treatment (internal fixation vs arthroplasty), and length of stay.CONCLUSION: The move from fee for service to prospective payment for postacute services for persons with hip fracture was associated with greater use of inpatient medical rehabilitation. Further research is necessary to confirm the trend in discharge setting and determine whether it is related to changes in reimbursement for postacute care.

Apixaban is an oral factor Xa inhibitor approved for stroke prevention in atrial fibrillation and thromboprophylaxis in patients who have undergone elective hip or knee replacement surgery and under development for treatment of venous thromboembolism. This study examined the safety, pharmacokinetics and pharmacodynamics of multiple dose apixaban.