• Gerben DeJong, Wenqiang Tian, Randall J Smout, Susan D Horn, Koen Putman, Ching-Hui Hsieh, Julie Gassaway, and Pamela Smith.
• 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):1306-16.

ObjectiveTo examine functional and health status outcomes of patients with joint replacement discharged from a skilled nursing facility (SNF) or an inpatient rehabilitation facility (IRF).DesignPostdischarge follow-up interview study at 7.5 months after admission.SettingFive freestanding SNFs, 1 hospital-based SNF, and 6 IRFs.ParticipantsPatients (N=856): 561 with knee replacement and 295 with hip replacement.InterventionsNone.Main Outcome MeasuresFIM and Short-Form 12-Item Health Survey (SF-12).ResultsAmong patients with knee and hip replacement, IRF patients made larger motor FIM gains from admission and discharge to follow-up. IRF patients, however, were admitted with lower FIM scores and also had more to gain (especially given the ceiling effects within the FIM at follow-up). When adjusted for case mix, IRF patients made larger motor FIM gains and had higher SF-12-related scores among patients with hip replacement but not among patients with knee replacement. Multivariate regressions found modest setting effects that favored IRFs, and the setting effects explained only a modest portion of the variance in motor FIM outcomes.ConclusionsAt follow-up, patients with joint replacement discharged from IRFs had better motor FIM outcomes than those discharged from freestanding SNFs and the hospital-based SNF. Settings did not differ materially in terms of SF-12 outcomes. Findings do not favor one setting decisively over another. A sole focus on initial postacute placement overlooks the larger trajectory of postacute care that needs to be managed to achieve superior outcomes.

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