An international comparison of long‐term care trajectories and spending following hip fracture

Abstract

Objective: The objectives of this study are to compare the relative use of different postacute care settings in different countries and to compare three important outcomes as follows: total expenditure, total days of care in different care settings, and overall longevity over a 1-year period following a hip fracture.Data Sources: We used administrative data from hospitals, institutional and homebased long-term care (LTC), physician visits, and medications compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) from five countries as follows: Canada, France, Germany, the Netherlands, and Sweden.Data Extraction Methods: Data were extracted from existing administrative data systems in each participating country.Study Design: This is a retrospective cohort study of all individuals admitted to acute care for hip fracture. Descriptive comparisons were used to examine aggregate institutional and home-based postacute care. Care trajectories were created to track sequential care settings after acute-care discharge through institutional and communitybased care in three countries where detailed information allowed. Comparisons in patient characteristics, utilization, and costs were made across these trajectories and countries.Principal Findings: Across five countries with complete LTC data, we found notable variations with Germany having the highest days of home-based services with relatively low costs, while Sweden incurred the highest overall expenditures. Comparisons of trajectories found that France had the highest use of inpatient rehabilitation. Germany was most likely to discharge hip fracture patients to home. Over 365 days, France averaged the highest number of days in institution with 104, Canada followed at 94, and Germany had just 87 days of institutional care on average. Conclusion:In this comparison of LTC services following a hip fracture, we found international differences in total use of institutional and noninstitutional care, longevity, and total expenditures. There exist opportunities to organize postacute care differently to maximize independence and mitigate costs.

A methodology for identifying high‐need, high‐cost patient personas for international comparisons

“…14 Finally, for countries that have access to data on long‐term care utilization and spending, an accompanying sixth paper examines the relative use of different types of long‐term and post‐acute care use among those who experience a hip fracture. 10 …”

“…14 Finally, for countries that have access to data on long-term care utilization and spending, an accompanying sixth paper examines the relative use of different types of long-term and post-acute care use among those who experience a hip fracture. 10 A key strength of the methodology presented in this article is that it segments the HNHC population into distinct patient types who require different types of care from the health system and therefore move across the care settings differently. We identified the two chosen personas from a hospitalization as the initial inciting event.…”

“…A fifth paper examines the within‐country variation of healthcare utilization and spending among people with complex multimorbidity (heart failure and diabetes) to better understand if there are important inequalities in care utilization across countries 14 . Finally, for countries that have access to data on long‐term care utilization and spending, an accompanying sixth paper examines the relative use of different types of long‐term and post‐acute care use among those who experience a hip fracture 10 …”

“…Finally, we demonstrate the comparability of these two specific personas—(1) an older adult with frailty who sustains a hip fracture and subsequent hip replacement or osteosynthesis, and (2) an older person with complex multimorbidity, specifically a person hospitalized with heart failure and a comorbidity of diabetes—across the 11 countries in the ICCONIC collaborative. Importantly, this work provides the methodological framework used in an accompanying six original research manuscripts copublished in the Health Services Research “Special Issue on International Comparisons of High Need, High‐Cost Patients.” 9 , 10 , 11 , 12 , 13 , 14 These six original research articles examine detailed variation in spending, utilization, and patient outcomes of the two specific high‐need patient cohorts across different care settings.…”

International comparison of patient care trajectories: Insights from the ICCONIC project

“…Across countries which had detailed data on post‐acute and long‐term care, there appeared to be some substitution between institutional‐ and community‐based (or home) rehab care. 15 …”