Comparing Survival Following Hip Fracture Repair in VHA and Non-VHA Facilities

Hutt, Evelyn; Radcliff, Tiffany A.; Henderson, William; Maciejewski, Matthew L.; Cowper-Ripley, Diane; Whitfield, Emily

doi:10.1177/2151458514561787

Cited by 4 publications

(14 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A similar system was implemented in the United States in November 1999, which was followed by vigorous studies comparing the therapeutic outcomes of patients admitted for emergencies between VH and CH in order to evaluate their benefit and reliability 7 8 9 10 11) . The purpose of the CH system is to ensure that there is no delay in treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac disease and hip fracture are conditions which require prompt treatment in order to reduce mortality 16 17 18) . Thus, a study on treatment delay and mortality is commonly used to evaluate the propriety of CH 8 9 10 11) . Such studies are actively conducted in the United States and many other countries 6 7 8 9 10 11 19) where VH systems are in place.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, a study on treatment delay and mortality is commonly used to evaluate the propriety of CH 8 9 10 11) . Such studies are actively conducted in the United States and many other countries 6 7 8 9 10 11 19) where VH systems are in place. Although Korea implemented the CH system 13 years prior to the United States, there are no studies comparing mortalities at VH vs. CH to analyze the propriety of the CH system for the surgical treatment of hip fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Although Korea implemented the CH system 13 years prior to the United States, there are no studies comparing mortalities at VH vs. CH to analyze the propriety of the CH system for the surgical treatment of hip fractures. Richardson et al 10) reported that admissions at CH were associated with a 21% lower relative risk of death within one year compared to VH admissions, while Hutt et al 9) reported that Medicare beneficiaries with hip fracture repair in non-VH had better survival rates than veterans in VH facilities. Several factors (e.g., the presence of other medical illnesses, severity of illnesses, and duration between injury and surgery) may affect mortality following a hip fracture 11 16 17 18) .…”

Section: Discussionmentioning

confidence: 99%

“…Evaluating the efficiency of the CH system can help ensure that veterans receive proper care and inform any necessary revisions. Whereas comparative studies on the treatment results between VH and CH have been undertaken internationally 6 7 8 9 10 11) , similar studies specific to Korea have not yet been conducted. We compared the 1-year survival rates and other clinical outcomes of patients treated for hip fractures at VH vs. CH to determine the operating status of the CH system.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

One-year Survival Rates and Functional Recovery in Veterans Who Suffer from Hip Fractures: Evaluation of Commissioned Hospitals' System through Comparison between Veterans Hospitals and Commissioned Hospitals

2018

View full text Add to dashboard Cite

PurposeThis study was performed to compare the: i) 1-year survival rate of patients with hip fractures, ii) factors affecting mortality in patients with hip fractures, and iii) results of functional recovery at commissioned hospitals (CH) and veterans hospitals (VH) to characterize the quality of care provided in the Korean commissioned hospital system.Materials and MethodsThe study population consisted of 183 veteran patients (84 and 99 treated at a single VH and 39 CH, respectively) who underwent hip fracture surgery between January 2010 and February 2015. This study compared baseline characteristics (i.e., age, comorbidities, fracture types and surgical treatment approaches) of the two groups vs. clinical outcomes, and evaluated the waiting time, length of hospital stay, total medical expenses, mortality rate within one year, and functional recovery at last follow up.ResultsThere were no significant differences in age, fracture types, comorbidities, ambulatory status before fracture, waiting time, or length of hospital stay between the two groups, however, the total medical cost was higher in the CH group (P=0.009). There was no significant difference in mortality within one year after hip fracture (P=0.224) or functional recovery at last follow-up (P=0.463) between the two groups.ConclusionThe results of this study confirm that the Korean commissioned hospitals system is operating in accordance with its purpose. However, further studies are needed to better characterize the medical expenses of CHs vs. veterans hospitals.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

One-year Survival Rates and Functional Recovery in Veterans Who Suffer from Hip Fractures: Evaluation of Commissioned Hospitals' System through Comparison between Veterans Hospitals and Commissioned Hospitals

2018

View full text Add to dashboard Cite

show abstract

Comparing Quality of Surgical Care Between the US Department of Veterans Affairs and Non-Veterans Affairs Settings: A Systematic Review

Blegen

Salzman

et al. 2023

Journal of the American College of Surgeons

View full text Add to dashboard Cite

In response to concerns about healthcare access and long wait times within the Veterans Health Administration (VA), Congress passed the Choice Act of 2014 and the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 to create a program for patients to receive care in non-VA sites of care, paid by VA. Questions remain about the quality of surgical care between these sites in specific and between VA and non-VA care in general. This review synthesizes recent evidence comparing surgical care between VA and non-VA delivered care across the domains of quality and safety, access, patient experience, and comparative cost/efficiency (2015 to 2021). Eighteen studies met the inclusion criteria. Of 13 studies reporting quality and safety outcomes, 11 reported that quality and safety of VA surgical care were as good as or better than non-VA sites of care. Six studies of access did not have a preponderance of evidence favoring care in either setting. One study of patient experience reported VA care as about equal to non-VA care. All 4 studies of cost/efficiency outcomes favored non-VA care. Based on limited data, these findings suggest that expanding eligibility for veterans to get care in the community may not provide benefits in terms of increasing access to surgical procedures, will not result in better quality, and may result in worse quality of care, but may reduce inpatient length of stay and perhaps cost less.

show abstract

Effect of Nonsurgical Versus Surgical Management on Geriatric Hip Fracture Mortality of Hispanic-American Male Veterans

Virgilio-Salgado

Olivella

Ruberte

et al. 2021

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

Introduction The effect of surgical vs nonsurgical management on hip fracture mortality of Hispanic-American male veterans has not been rigorously studied. Hence, we examined the mortality and life expectancy effect of nonsurgical vs surgical management after hip fracture in a geriatric Hispanic-American male veterans’ population. Material and Methods This was a retrospective cohort study of Hispanic-American male veterans who were 65 years of age or older and suffered a femoral neck or intertrochanteric fracture from January 2008 to December 2015. Analysis between a surgical cohort (cannulated screw fixation, hemiarthroplasty, total hip arthroplasty, or cephalomedullary nail) and a non-surgical cohort was performed. In-hospital, 30-day, one-year, and two-year mortality were compared between both groups. Results Out of 268 patients with hip fracture, 159 (59.2%) were treated surgically and 109 (40.8%) non-surgically. The overall in-hospital (9.2% vs 1.9%, P = .009), 30-day (17.4% vs 5.0%, P = .002), one-year (48.6% vs 23.3%, P < .001), and two-year (63.3% vs 36.5%, P < .001) mortality rate was found to be higher for the nonoperative group. The average life expectancy of the nonoperative cohort was significantly shorter than those who were managed surgically (216 days vs 260 days, P < .001). Discussion and Conclusion This study shows a higher mortality rate and lower life expectancy in geriatric male patients who were treated nonsurgically in a Veterans Health Affair hospital facility that mostly serves Hispanic-American veterans. Our results provide an expansion to the findings of other geriatric studies on hip fracture with focus in a Hispanic-American veteran male population.

show abstract

Comparing Survival Following Hip Fracture Repair in VHA and Non-VHA Facilities

Abstract: Medicare beneficiaries with hip fracture repair in non-VHA hospitals had better survival than veterans in VHA hospitals. Whether this is driven by unobserved patient characteristics or systematic care differences is unknown.

Cited by 4 publications

References 24 publications

One-year Survival Rates and Functional Recovery in Veterans Who Suffer from Hip Fractures: Evaluation of Commissioned Hospitals' System through Comparison between Veterans Hospitals and Commissioned Hospitals

One-year Survival Rates and Functional Recovery in Veterans Who Suffer from Hip Fractures: Evaluation of Commissioned Hospitals' System through Comparison between Veterans Hospitals and Commissioned Hospitals

Comparing Quality of Surgical Care Between the US Department of Veterans Affairs and Non-Veterans Affairs Settings: A Systematic Review

Effect of Nonsurgical Versus Surgical Management on Geriatric Hip Fracture Mortality of Hispanic-American Male Veterans

Contact Info

Product

Resources

About