Disparities in length of stay for hip fracture treatment between patients treated in safety-net and non-safety-net hospitals

Abstract

Background: Length of hospital stay (LOS) for hip fracture treatments is associated with mortality. In addition to patient demographic and clinical factors, hospital and payer type may also influence LOS, and thus mortality, among hip fracture patients; accordingly, outcome disparities between groups may arise from where patients are treated and from their health insurance type. The purpose of this study was to examine if where hip fracture patients are treated and how they pay for their care is associated with outcome disparities between patient groups. Specifically, we examined whether LOS differed between patients treated at safety-net and non-safety-net hospitals and whether LOS was associated with patients' insurance type within each hospital category. Methods: A sample of 48,948 hip fracture patients was extracted from New York State's Statewide Planning and Research Cooperative System (SPARCS), 2014-2016. Using means comparison and X 2 tests, differences between safety-net and non-safety-net hospitals on LOS and patient characteristics were examined. Relationships between LOS and hospital category (safety-net or non-safety-net) and LOS and insurance type were further evaluated through negative binomial regression models. Results: LOS was statistically (p ≤ 0.001) longer in safety-net hospitals (7.37 days) relative to non-safety-net hospitals (6.34 days). Treatment in a safety-net hospital was associated with a LOS that was 11.7% (p = 0.003) longer than in a non-safety-net hospital. Having Medicaid was associated with a longer LOS relative to having commercial health insurance. Conclusion: Where hip fracture patients are treated is associated with LOS and may influence outcome disparities between groups. Future research should examine whether outcome differences between safety-net and non-safety-net hospitals are associated with resource availability and hospital payer mix.

The case for decreased surgeon-reported complications due to surgical volume and fellowship status in the treatment of geriatric hip fracture: An analysis of the ABOS database

“…Conversely, they did find a relationship between high surgeon volume and shorter lengths of stay [18,35,36]. As shorter lengths of stay after hip fractures have been shown to reduce rates of early mortality, this may also support the case volume findings of the current study [37,38].…”

Association of Patient-Level and Hospital-Level Factors With Timely Fracture Care by Race

“… 8 , 27 The results of this study are also consistent with several prior studies demonstrating delays in hip fracture treatment among racial and ethnic minority patients 6 , 8 , 12 , 27 , 28 and worse outcomes among racial and ethnic minority patients. 5 , 6 , 8 , 9 , 10 , 11 , 28 As these studies only evaluated disparities on the patient level, it is impossible to know whether their findings were due to patient-specific biases or structural health systems issues. The results of this study were also consistent with a study within the Kaiser Permanente patient population demonstrating that in their integrated managed care system, in which all patients have health insurance coverage, racial and ethnic minority patients with hip fracture had postoperative mortality rates similar to, or lower, than White patients.…”

“…There are several strengths associated with this study. This study leveraged a high-quality prospectively collected, adjudicated data set that had advantages in validity over prior research using administrative data (such as the National Inpatient Sample, Trauma Quality Improvement Program, American College of Surgeons National Surgical Quality Improvement Program or New York State’s Statewide Planning and Research Cooperative System) 5 , 8 , 12 , 27 , 28 that are subject to issues with inconsistent reporting and coding inaccuracies 13 , 14 or single center studies. 6 , 31 Furthermore, this analysis included several time-sensitive fractures, both of which demonstrated the same effect in the primary analysis suggesting that this association was more widespread across injuries and not limited to a specific injury type.…”

“…Racial inequalities relating to health care utilization and outcomes are well documented across many medical specialties, [1][2][3][4] including orthopedic trauma. [5][6][7][8][9][10][11] To date, studies in fracture populations have been limited to geriatric patients with hip fractures and have demonstrated that Black patients have a higher likelihood of nonoperative treatment. 12 Additionally, when Black patients are treated surgically, they experience longer delays to surgery, [6][7][8] as well as worse postoperative outcomes, including higher rates of revision surgery, readmission, and 1-year mortality.…”

Predicting Prolonged Hospital Stays in Elderly Patients With Hip Fractures Managed During the COVID-19 Pandemic in Chile: An Artificial Neural Networks Study

“…The 3 organizational/administrative factors mentioned above are well known as a source of disparity for outcomes that are relevant in hip fracture patients. For instance, a study conducted in New York, USA, demonstrated that LOS depends on the type of hospital where the patient was managed; safety-net hospitals (those that cover uninsured or Medicaid patients) have a longer LOS compared with non-safety net hospitals [ 4 ].…”