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In Reply.—Dr Lipson's letter addressing our article titled "The Impact of the Prospective Payment System on the Treatment of Hip Fractures in the Elderly" raises an interesting point that we feel deserves further attention. Namely, does the placement of elderly hip fracture patients in an intensive short-term care (30-day) rehabilitation hospital result in more favorable patient outcomes than those achieved by clinically and demographically comparable patients discharged to a skilled nursing facility? It certainly seems plausible that patients with hip fractures treated at rehabilitation hospitals could have more favorable outcomes.
Before addressing the methodological issues, we must point out that Dr Lipson did not use the same calculation to determine the retention rate for our study hospital as he did for his hospital. Dr Lipson calculated a 5.2% retention rate for his patients: 6% are admitted to nursing homes and 86% are still there at follow-up (86% × 6%
PALMER RM, SAYWELL RM, ZOLLINGER TW. Differences in Outcome: Hospital Rehabilitation vs Skilled Nursing Facility Rehabilitation-Reply. Arch Intern Med. 1990;150(7):1551. doi:10.1001/archinte.1990.00390190180039