Post-Acute Care Setting After Hip Fracture Hospitalization and Subsequent Opioid Use in Older Adults.

This was an observational Medicare claims study, not a randomised comparison of SNF and IRF care, so it cannot show that the setting caused the difference in opioid use. Part D claims did not capture opioids given during hospitalization or institutional PAC because of bundled payment, so some post-PAC use may reflect medications already started but not measured. The data lacked pain severity and indications, so the study could not judge whether opioid use matched pain or whether it was appropriate. Patients were not required to be opioid naïve, and pre-fracture opioid use was not assessed, so some dispensings may not have been related to the hip fracture. SNF and IRF patients differed before adjustment: SNF patients were older, more often female, had more comorbidities, and stayed longer in PAC. The sample excluded patients discharged to home health, long-term acute care hospitals, multiple PAC settings, and Medicare Advantage beneficiaries, so findings do not cover all older adults after hip fracture. Discharge to each setting depends on factors not captured in claims, such as bed availability, family support, financial and racial disparities, and case management. The 7-day dispensing window was used to define discharge prescribing, which may not capture all home medications or exact discharge practice.

The authors declared no conflicts of interest. The article is listed as supported by NIH extramural research.

Do not conclude that skilled nursing facility care reduces opioid use compared with inpatient rehabilitation. This was an observational claims study, not a randomised treatment comparison, and patients differed before discharge. When opioids dispensed within 7 days of leaving post-acute care were excluded, the adjusted hazard of any opioid use was only 17% lower for skilled nursing facility versus inpatient rehabilitation.