Cost of care for seniors hospitalized for hip fracture and related procedures

Titler, Marita G.; Dochterman, Joanne; Kim, Taikyoung; Kanak, Mary; Shever, Leah L.; Picone, Debra M.; Everett, Linda Q.; Budreau, Ginette

doi:10.1016/j.outlook.2006.06.006

Cited by 33 publications

(42 citation statements)

References 11 publications

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“…Several studies have shown that inpatient hospital costs are the largest single medical cost for patients who have sustained a hip fracture. 7,9,13,15,27,28 This study evaluates inpatient hospital costs for 797 hip fractures (776 patients) treated in a comanaged protocol-driven program. The results show significantly lower costs than those found for US national averages.…”

Section: Discussionmentioning

confidence: 99%

“…The costs of skilled nursing and rehabilitation facilities, home care, outpatient care, and loss of work or productivity or opportunity were not evaluated. [7][8][9]15,19,28 We chose to focus on the acute hospital costs because they are most directly related to the comanagement model at our institution. Another limitation is that the data are compared to average costs to Medicare and do not adjust for patient characteristics.…”

Section: Limitations Of This Studymentioning

confidence: 99%

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Comparison of an Organized Geriatric Fracture Program to United States Government Data

Kates

Blake

Bingham

et al. 2010

Geriatr Orthop Surg Rehabil

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Objective: This study describes the financial impact of an organized hip fracture program for elderly patients age 65 years and older. Methods: This is a retrospective study of 797 fractures in 776 consecutive patients over a 50-month period (May 2005 to July 2009) treated in an organized hip fracture program for the elderly identified from a quality management database. Financial, demographic, and quality-of-care data were collected. The length of hospital stay, in-hospital complications, and Charlson comorbidity scores were collected from patient records, and all data were evaluated using standard statistical methods. Setting: 261-bed community-based, university-affiliated teaching hospital in an urban setting with a catchment area of approximately 1 million persons. This is a level 3 trauma center. Results: The average total net revenue per hip fracture was $12 159, with an average total cost to hospital of $8264. Physicians' fees consisted of fees collected by surgeons, anesthesiologists, medical specialty consultants, and consulting geriatricians and averaged $2024 per case. Thus, the average hospital charge to payers was $15 188. Compared to Agency for Healthcare Research and Quality average inpatient hospital costs in 2005 of $33 693, a savings of more than $18 000 was realized per patient. The average length of stay was 4.6 days, markedly less than the national average of 6.2 days. Conclusions: This organized geriatric fracture care model with geriatrics comanagement resulted in significant cost savings over a 50-month period, with associated increased quality. With an estimated 330 000 hip fractures annually in the United States, a large cost savings could potentially be realized if this model were more widely applied.

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Section: Discussionmentioning

confidence: 99%

Section: Limitations Of This Studymentioning

confidence: 99%

Comparison of an Organized Geriatric Fracture Program to United States Government Data

Kates

Blake

Bingham

et al. 2010

Geriatr Orthop Surg Rehabil

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“…These comprised patient characteristics [7], [12], [20], [21], [22], [23], [24], [25], [26], [27], Case Mix Group (CMG), DRG (Appendix S4), nursing diagnoses [7], [21], [24], [28], [29], [30] (Appendix S4), severity of illness [9], [22], [23], [25], [26], [30], [31], [32] (Appendix S5), patient acuity [12], [24], [30] (Appendix S5), comorbidities [7], [23], complications [7], [23], [25], [26], [33] and admission and discharge factors [22]. Three studies [21], [23], [30] investigated models estimating the demand for hospital care services.…”

Section: Resultsmentioning

confidence: 99%

“…Different outcomes were used to determine the amount of hospital care services demanded: five studies used nursing hours spent [9], [28], [29], [31], two studies used resource consumption [20], [32], three studies used nursing workload [12] or nursing workload as measured by a PCS [21], [22], Sermeus et al [30] only used nursing care intensity, and seven studies used hospitalization costs [7], [23], [24], [25], [26], [27], [33]. Physician services, if investigated at all, were done so only indirectly.…”

Section: Resultsmentioning

confidence: 99%

Factors and Models Associated with the amount of Hospital Care Services as Demanded by Hospitalized Patients: A Systematic Review

et al. 2014

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BackgroundHospitals are constantly being challenged to provide high-quality care despite ageing populations, diminishing resources, and budgetary restraints. While the costs of care depend on the patients' needs, it is not clear which patient characteristics are associated with the demand for care and inherent costs. The aim of this study was to ascertain which patient-related characteristics or models can predict the need for medical and nursing care in general hospital settings.MethodsWe systematically searched MEDLINE, Embase, Business Source Premier and CINAHL. Pre-defined eligibility criteria were used to detect studies that explored patient characteristics and health status parameters associated to the use of hospital care services for hospitalized patients. Two reviewers independently assessed study relevance, quality with the STROBE instrument, and performed data analysis.ResultsFrom 2,168 potentially relevant articles, 17 met our eligibility criteria. These showed a large variety of factors associated with the use of hospital care services; models were found in only three studies. Age, gender, medical and nursing diagnoses, severity of illness, patient acuity, comorbidity, and complications were the characteristics found the most. Patient acuity and medical and nursing diagnoses were the most influencing characteristics. Models including medical or nursing diagnoses and patient acuity explain the variance in the use of hospital care services for at least 56.2%, and up to 78.7% when organizational factors were added.ConclusionsA larger variety of factors were found to be associated with the use of hospital care services. Models that explain the extent to which hospital care services are used should contain patient characteristics, including patient acuity, medical or nursing diagnoses, and organizational and staffing characteristics, e.g., hospital size, organization of care, and the size and skill mix of staff. This would enable healthcare managers at different levels to evaluate hospital care services and organize or reorganize patient care.

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“…These approaches vary in rigor from simple aggregation of costs subsequent to a fracture diagnosis [37][38][39] to matching estimators that compare the costs of similar individuals with and without fractures [40][41][42]. The latter will generate biased estimates if they fail to account for unobservable factors that affect fracture risk and health expenditures.…”

Section: Costsmentioning

confidence: 99%

The Societal Burden of Osteoporosis

2010

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Osteoporosis currently affects 10 million Americans and is responsible for more than 1.5 million fractures annually. The financial burden of osteoporosis is substantial, with annual direct medical costs estimated at 17 to 20 billion dollars. Most of these costs are related to the acute and rehabilitative care following osteoporotic fractures, particularly hip fractures. The societal burden of osteoporosis includes these direct medical costs and the monetary (eg, caregiver time) and nonmonetary costs of poor health. The aging of the US population is expected to increase the prevalence of osteoporosis and the number of osteoporotic fractures. Growth of the older adult population will pose significant challenges to Medicare and Medicaid, which bear most of the cost of osteoporosis. Efforts to address the looming financial burden must focus on reducing the prevalence of osteoporosis and the incidence of costly fragility fractures.

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Cost of care for seniors hospitalized for hip fracture and related procedures

Cited by 33 publications

References 11 publications

Comparison of an Organized Geriatric Fracture Program to United States Government Data

Comparison of an Organized Geriatric Fracture Program to United States Government Data

Factors and Models Associated with the amount of Hospital Care Services as Demanded by Hospitalized Patients: A Systematic Review

The Societal Burden of Osteoporosis

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