Abstract
BackgroundLength 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.MethodsA 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 X2 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.ResultsLOS 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.ConclusionWhere 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.
Highlights
Length of hospital stay (LOS) for hip fracture treatments is associated with mortality
The average Length of stay (LOS) for hip fracture patients treated at Safety-net hospitals (SNH), 7.37 days, was statistically different (p < 0.001) from the average LOS of patients treated at NSNH, 6.34 days
It was estimated that SNH, on average, had larger shares of patients who were under 70 years of age, male, non-White, and of Spanish/Hispanic descent relative to NSNH
Summary
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 influence LOS, and mortality, among hip fracture patients; outcome disparities between groups may arise from where patients are treated and from their health insurance type. Patient comorbidities [2,3,4,5,6], demographic characteristics [7,8,9], and support networks or living arrangements upon discharge [5, 10, 11] have all been found to influence hip fracture treatment outcomes. Safety-net hospitals (SNH) by definition provide a large amount of their services to uninsured persons, people with Medicaid health insurance, and other vulnerable populations [19]. In a systematic review, Oner et al [22] found, in the only two studies with significant results (out of eight), a negative relationship between hospitals’ total margins and hospitals’ Medicaid payer mix share
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