No abstract

No abstract

Objectives To evaluate whether the Hospital Admission Risk Profile (HARP) score is associated with skilled nursing or acute rehabilitation facility discharge following an acute hospitalization. Design Retrospective cohort study Setting One inpatient unit of a rural, academic medical center Participants Hospitalized patients 70 years or older from October 1, 2013 to June 1, 2014 Measurements Patient age at the time of admission, modified Folstein Mini-Mental Status Exam score, and self-reported instrumental activities of daily living two weeks prior to admission were used to calculate a HARP score. The primary predictor was HARP score and the primary outcome was discharge disposition (home, facility, or deceased). Multivariate analysis evaluated the association between HARP score and discharge disposition adjusting for age, sex, comorbidities, and length of stay. Results Four hundred twenty eight patients, admitted from home, were screened and categorized by HARP score as low (162 [37.8%]), intermediate (157 [36.7%]), or high (109 [25.5%]). Patients with high HARP scores were significantly more likely to be discharged to a facility compared to those with low HARP scores (55% vs. 20%; p<0.001). After adjustment, patients with high compared to low HARP scores were over 4 times more likely to be discharged to a facility (OR 4.58, 95% CI 2.42–8.66). Conclusion Among a population of older hospitalized adults, the HARP score (using readily available admission information) identifies patients at increased risk for skilled nursing or acute rehabilitation facility discharge. Early patient identification for potential facility discharges may allow for targeted interventions to prevent functional decline, improve informed shared decision-making about post-acute care needs, and expedite discharge planning.

Background/Objectives Recurrent fracture risk is high among fragility fracture survivors. Osteoporosis treatment reduces recurrent fractures and consequent morbidity and mortality. To assess uptake of post-fracture care guidelines, we studied osteoporosis care in a national cohort of community-dwelling, Medicare patients with fractures. Design Retrospective, observational cohort study. Setting Claims based study using U.S. Medicare administrative inpatient, outpatient (2003–2010) and prescription (2006–2010) data. Participants Patients 68 years or older who survived at least 12 months after a fracture of the hip, radius or humerus Measurements Poisson regression modeled factors, including patient characteristics, co-morbidities and hospital referral region (HRR), associated with bone density testing and/or osteoporosis pharmacotherapy in the 6 months following fracture. Models were repeated for patients with no osteoporosis care observed prior to fracture (“attention naïve”). Results Among 61,832 fracture patients, mean age was 80.6; 87.0% were female; 88.5% were white; 2.6% were Black; 62.1% were “attention naïve” at the time of fracture. 21.8% received testing and/or pharmacotherapy in the 6 months following fracture. In adjusted models, factors associated with significantly lower likelihood of receiving this care were: Black race, male sex, and an upper extremity fracture (vs. hip). In models restricted to “attention naïve” patients the same factors were associated with lower RRs of achieving care. Adjusted HRR-level care rates ranged from 14.7%–22.9% (10th to 90th percentile). The proportion receiving care increased from 2006 to 2009. Conclusion Post-fracture osteoporosis care was uncommon, particularly among Black and male patients. Care increased over time, but for most a fracture was insufficient to trigger effective secondary prevention, especially for patients without pre-fracture osteoporosis attention. Clinicians and policy makers must consider effective remedies to this persistent care gap.