In-patient rehabilitation outcomes following lower extremity fracture in patients with pneumonia.
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.
['Ahmed|Ijaz|I|', 'Graham|James E|JE|', 'Karmarkar|Amol M|AM|', 'Granger|Carl V|CV|', 'Ottenbacher|Kenneth J|KJ|']
D000368:Aged D000369:Aged, 80 and over D005260:Female D050723:Fractures, Bone D006760:Hospitalization D006801:Humans D007867:Leg Bones D008297:Male D008875:Middle Aged D010384:Pelvic Bones D011014:Pneumonia D020127:Recovery of Function D012189:Retrospective Studies D016896:Treatment Outcome
outcomes comorbidity evaluation disability post-acute care