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Determinants of postacute care discharge destination after dysvascular lower limb amputation. PM R 2011 Apr;3(4):336-44

Date

04/19/2011

Pubmed ID

21497320

Pubmed Central ID

PMC5391794

DOI

10.1016/j.pmrj.2010.12.019

Scopus ID

2-s2.0-79954623916 (requires institutional sign-in at Scopus site)   33 Citations

Abstract

OBJECTIVE: To examine the factors affecting postacute care discharge decisions among persons undergoing major lower limb amputations as a result of dysvascular causes.

DESIGN: A population-based, multicenter prospective study.

SETTING: Eighteen participating hospitals in Baltimore, Maryland, and Milwaukee, Wisconsin, served as the referral base for this study.

PATIENTS: The study population consisted of patients aged 21 years or older who underwent a major (foot or higher level) lower limb amputation as a result of dysvascular causes.

METHODS: Patients were identified and recruited during their acute hospital admission at one of the participating hospitals. Data were drawn from (1) acute care medical chart reviews; (2) surveys administered shortly after patients underwent amputation, while they were receiving acute care, that assessed their function the month before amputation and other demographic and social information; and (3) a 6-month follow-up telephone interview.

MAIN OUTCOME MEASURES: The outcome of interest was the postacute discharge setting in which the initial rehabilitation services, if any, were delivered to the patient during the reference period of 6 months after index amputation surgery. Discharge to alternative postacute settings--inpatient rehabilitation facility (IRF), skilled nursing facility (SNF, reference category), and home--were contrasted with use of t- and χ(2) test statistics. A 3-category, multinominal logit model was used to examine the independent effects of sociodemographic, geographic, health, and amputation-related characteristics on the likelihood of discharge to alternative settings.

RESULTS: A total of 348 patients consented to participate in the study, with an overall participation rate of 87.1%. One hundred ninety-two patients (55.2%) were discharged to an IRF, 73 (21%) were discharged to an SNF, and 83 (23.8%) were discharged directly home. The mean age of the sample was 63.7 years; the majority (59.2%) were men, and more than one quarter African Americans. More than half of those reporting were poor (income <$15,000/year). On average, patients had 5 co-morbidities, and nearly half had an amputation at the below-knee level. Discharge to an IRF (versus an SNF) was more likely in patients who were married, had greater cognitive functioning, had unilateral below-knee amputations, had Medicaid coverage, and were living in Milwaukee, Wisconsin. Patients were less likely to be discharged home (versus to an SNF) if they were older, unmarried, had a previous history of nursing home residence, and had more perioperative complications. Discharge destination was not affected by gender or race.

CONCLUSION: Postacute care decisions largely appear to be made on the basis of medical and family support factors. The findings of this research provide a necessary first step in the challenging task of assessing and quantitatively modeling the long-term functional outcomes of persons who receive postacute care in alternative settings by allowing more optimal case mix adjustment for factors that simultaneously influence rehabilitation setting and outcomes.

Author List

Dillingham TR, Yacub JN, Pezzin LE

Author

Liliana Pezzin PhD, JD Professor in the Institute for Health and Equity department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Female
Follow-Up Studies
Home Care Services
Humans
Lower Extremity
Male
Middle Aged
Patient Discharge
Peripheral Vascular Diseases
Prospective Studies
Rehabilitation Centers
Skilled Nursing Facilities