Abstract
ObjectiveThis study explores differences in spending and utilization of health care services for an older person with frailty before and after a hip fracture.Data SourcesWe used individual‐level patient data from five care settings.Study DesignWe compared utilization and spending of an older person aged older than 65 years for 365 days before and after a hip fracture across 11 countries and five domains of care as follows: acute hospital care, primary care, outpatient specialty care, post–acute rehabilitative care, and outpatient drugs. Utilization and spending were age and sex standardized..Data Collection/Extraction MethodsThe data were compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries as follows: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States.Principal FindingsThe sample ranged from 1859 patients in Spain to 42,849 in France. Mean age ranged from 81.2 in Switzerland to 84.7 in Australia. The majority of patients across countries were female. Relative to other countries, the United States had the lowest inpatient length of stay (11.3), but the highest number of days were spent in post–acute care rehab (100.7) and, on average, had more visits to specialist providers (6.8 per year) than primary care providers (4.0 per year). Across almost all sectors, the United States spent more per person than other countries per unit ($13,622 per hospitalization, $233 per primary care visit, $386 per MD specialist visit). Patients also had high expenditures in the year prior to the hip fracture, mostly concentrated in the inpatient setting.ConclusionAcross 11 high‐income countries, there is substantial variation in health care spending and utilization for an older person with frailty, both before and after a hip fracture. The United States is the most expensive country due to high prices and above average utilization of post–acute rehab care.
Highlights
A key challenge faced by many health systems is how to best design services to provide care to a small number of high-need high-cost (HNHC) patients
Making use of patient-level datasets linked across multiple care settings—spanning primary care, specialty services, acute hospital care, and post–acute care—we explored the variations in utilization and costs of health services across care settings and health systems in the 365 days before and after a hip fracture
We focused on patients older than 65 years across all systems, who were admitted to hospital with a primary diagnosis of hip fracture, which can be identified using the International Classification of Diseases–10th revision (ICD-10) diagnostic codes, as defined by the World Health Organization: S72.0, S72.1, and S72.2
Summary
A key challenge faced by many health systems is how to best design services to provide care to a small number of high-need high-cost (HNHC) patients. One important group of HNHC patients is older adults with frailty. Frail older adults are weak, often have multiple complex medical needs, and often require assistance for daily activities (such as dressing, eating, toileting, mobility, etc.). It is critical for health systems to identify ways to optimize care their care. One way to do this is by examining how care patterns for older patients with frailty vary across systems and, importantly, understanding how best practices can be applied from one health system to another
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