• Gerben DeJong, Wenqiang Tian, Randall J Smout, Susan D Horn, Koen Putman, Pamela Smith, Julie Gassaway, and Joan E Davanzo.
• Center for Post-acute Studies, National Rehabilitation Hospital, Washington, DC 20010, USA. Gerben.DeJong@MedStar.net
• Arch Phys Med Rehabil. 2009 Aug 1;90(8):1297-305.

ObjectiveTo compare use of rehabilitation and other health services among patients with knee and hip replacement after discharge from a skilled nursing facility (SNF) or an inpatient rehabilitation facility (IRF).DesignFollow-up interview study at 7.5 months after discharge.SettingFive freestanding SNFs, 1 hospital-based SNF, and 6 IRFs from across the United States.ParticipantsPatients (N=856): patients with knee replacement (n=561) and patients with hip replacement (n=295).InterventionsNo interventions.Main Outcome MeasuresNumber of home and outpatient therapy visits, physician visits, emergency room visits, rehospitalizations, and medical complications.ResultsAfter discharge from postacute care, the vast majority of patients received home rehabilitation, outpatient rehabilitation, or both. Patients with knee replacement received an average of 19 home and/or outpatient rehabilitation visits; patients with hip replacement received almost 15 visits. There were no statistically significant differences in rates of emergency room use and rehospitalization except that patients with hip replacement discharged from IRFs had higher rates of rehospitalization than those discharged from freestanding SNFs (15.8% vs 3.1%). Multivariate analyses did not find any SNF/IRF effects.ConclusionsPatients with joint replacement from both SNFs and IRFs receive considerable amounts of follow-up rehabilitation care. Study uncovered no setting effects related to rehospitalization or medical complications. Looking only at care rendered in the initial postacute setting provides an incomplete picture of all care received and how it may affect follow-up outcomes.

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