Comparing the Contributions of Acute and Postacute Care Facility Characteristics to Outcomes After Hospitalization for Hip Fracture

Abstract

OBJECTIVE To quantify the contribution of acute versus post-acute care factors to survival and functional outcomes after hip fracture. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study using Medicare data; subjects included previously ambulatory nursing home residents hospitalized for hip fracture between 2005 and 2009. METHODS We used logistic regression to measure the associations of hospital and nursing home factors with functional and survival outcomes at 30 and 180 days among patients discharged to a nursing facility; we quantified the contribution of hospital versus nursing home factors to outcomes via the omega statistic. RESULTS Among 45,996 hospitalized patients, 1,814 (3.9%) died during hospitalization. 42,781 (93%) were discharged alive to a nursing home. Of these, 12,126 (28%) died within 180 days and 20,479 (48%) died or were newly unable to walk within 180 days. Hospital characteristics were not consistently associated with outcomes. Multiple nursing home characteristics predicted 30- and 180-day outcomes, including bed count, chain membership, and performance on selected quality measures. Nursing home factors explained three times more variation in the odds of 30-day mortality than did hospital factors (omega, hospital versus nursing home: 0.32, 95% confidence interval (CI) 0.11, 0.96), seven times more variation in the odds of 180-day mortality (omega: 0.15, 95% CI 0.04, 0.61), and eight times more variation in the odds of 180-day death or new dependence in locomotion (omega: 0.12, 95% CI 0.05, 0.31). CONCLUSIONS Nursing home factor sex plain a larger proportion of the variation in clinical outcomes following hip fracture than do hospital factors.

Effect of Preoperative Geriatric Evaluation on Outcomes After Elective Surgery: A Population‐Based Study

“…In other words, perhaps discharging older adults after surgery with support contributes to better survival. Characteristics of postdischarge care were found to affect survival after emergency hip fracture surgery to a greater degree than in‐hospital care . Perhaps similar mechanisms contribute with elective surgery in older adults.…”

“…Characteristics of postdischarge care were found to affect survival after emergency hip fracture surgery to a greater degree than in-hospital care. 34 Perhaps similar mechanisms contribute with elective surgery in older adults.…”

Facility and State Variation in Hip Fracture in U.S. Nursing Home Residents

“…Surprisingly few data are available about the contribution of facility-level characteristics to the occurrence of hip fractures in NHs, though prior studies have examined the contribution of such characteristics to post-fracture outcomes. [3, 40] We identified several modifiable facility-level characteristics that were associated with greater rates of hip fracture. These included the percentages of residents prescribed antipsychotic, antidepressant, antianxiety, and psychoactive medications.…”

Socioeconomically‐deprived patients suffer hip fractures at a younger age and require more hospital admissions, but early mortality risk is unchanged: The IMPACT Deprivation Study

“…With the benefit of national hip fracture registries, many factors associated with poor outcomes are well understood. There is extensive evidence demonstrating the association between adverse outcome and patient-related factors such as male sex, increased age, frailty, co-morbidity, the presence of cognitive impairment and dementia, and communicable disease such as COVID-19 (Clague et al, 2002;Dailiana et al, 2013;Hall et al, 2022;Narula et al, 2020;Neuman et al, 2017;Rostagno et al, 2016). Various service-related factors have also been demonstrated to be associated with poorer outcomes including delayed time to theatre, hospital case-volume, day of admission, and adherence to national care standards (Farrow et al, 2018(Farrow et al, , 2020(Farrow et al, , 2021Metcalfe et al, 2019).…”