Clinical Evaluation and Research in Occupational Therapy: Single System Designs

In this paper the authors present single system designs as a framework for the collecting, organising and analysing of information to evaluate programme impact. The steps involved in evaluation and research using single system designs are discussed and advantages and disadvantages of the design for occupational therapists are briefly presented. The authors conclude that single system designs are suitable for occupational therapists to use in research and clinical evaluation because of their flexibility and their emphasis on clinical significance.     

Diabetes comorbidity and age influence rehabilitation outcomes after hip fracture

OBJECTIVE

To examine the influence of diabetes on length of stay (LOS), functional status, and discharge setting in individuals with hip fracture.

RESEARCH DESIGN AND METHODS

This work included secondary analyses of 79,526 individuals from 915 rehabilitation facilities in the U.S. Patients were classified into three groups using the Centers for Medicare and Medicaid Services comorbidity structure: individuals without diabetes (77.0%), individuals with non-tier diabetes (18.3%), and individuals with tier diabetes (4.7%).

RESULTS

Mean age was 79.4 years (SD 9.6), and mean LOS was 13.3 days (SD 5.3). Tier diabetes was associated with longer LOS, lower functional status ratings, and reduced odds of discharge home when compared with individuals with no diabetes and non-tier diabetes. Statistically significant interactions (P < 0.05) were found between age and diabetes classification for LOS, functional status, and discharge setting.

CONCLUSIONS

The impact of diabetes on recovery after hip fracture is moderated by age.Diabetes is a frequent comorbid condition in older adults and may complicate recovery from hip fracture (1–3). The Centers for Medicare and Medicaid Services (CMS) prospective payment system for inpatient rehabilitation assigns each patient to a case mix group, and they may also be assigned to a comorbidity tier (4). The comorbidity tier system has four reimbursement-related levels: tier 1 (high cost), tier 2 (medium cost), tier 3 (low cost), and tier 4 (no-cost increase) (5,6). Selected diabetes diagnoses (ICD-9 codes) are classified as tier 3 comorbidities (see below).We examined CMS-assigned diabetes comorbidity tier status and patient outcomes in a large national sample of people who received inpatient medical rehabilitation after a hip fracture. We hypothesized that individuals with tier 3 comorbid diabetes would have longer lengths of stay, have poorer functional outcomes, and be discharged home less frequently than people with non-tier diabetes or no diabetes.