Abstract
BackgroundHip fractures among older adults are one of the leading causes of hospitalization and result in significant morbidity, mortality, and health care use. Guidelines suggest that rehabilitation after surgery is imperative to return patients to pre-morbid function. However, post-acute care (which encompasses rehabilitation) is currently delivered in a multitude of settings, and there is a lack of evidence with regards to which hip fracture patients should use which post-acute settings. The purpose of this study is to describe hip fracture patient characteristics and the most common post-acute pathways within a 1-year episode of care, and to examine how these vary regionally within a health system.MethodsThis study took place in the province of Ontario, Canada, which has 14 health regions and universal health coverage for all residents. Administrative health databases were used for analyses. Community-dwelling patients aged 66 and over admitted to an acute care hospital for hip fracture between April 2008 and March 2013 were identified. Patients’ post-acute destinations within each region were retrieved by linking patients’ records within various institutional databases using a unique encoded identifier. Post-acute pathways were then characterized by determining when each patient went to each post-acute destination within one year post-discharge from acute care. Differences in patient characteristics between regions were detected using standardized differences and p-values.ResultsThirty-six thousand twenty nine hip fracture patients were included. The study cohort was 71.9 % female with a mean age of 82.9 (±7.5SD). There was significant variation between regions with respect to the immediate post-acute discharge destination: four regions discharged a substantially higher proportion of their patients to inpatient rehabilitation compared to all others. However, the majority of patient characteristics between those four regions and all other regions did not significantly differ. There were 49 unique post-acute pathways taken by patients, with the largest proportion of patients admitted to either community-based or short-term institutionalized rehabilitation, regardless of region.ConclusionsThe observation that similar hip fracture patients are discharged to different post-acute settings calls into question both the appropriateness of care delivered in the post-acute period and health system expenditures. As policy makers continue to develop performance-based funding models to increase accountability of institutions in the provision of quality care to hip fracture patients, ensuring patients receive appropriate rehabilitative care is a priority for health system planning.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1524-1) contains supplementary material, which is available to authorized users.
Highlights
Hip fractures among older adults are one of the leading causes of hospitalization and result in significant morbidity, mortality, and health care use
The 14 health regions vary in the number of people served, funding distribution, and the number of health care institutions, but all health regions possess the following post-acute care destinations: Long-term care facilities (LTC); complex continuing care facilities (CCC) for longerterm rehabilitation or patients with complex medical conditions; inpatient rehabilitation facilities (IPR) for short-term rehabilitation (i.e., 30 days or less); and home care (HC), which may include home-based rehabilitation (HBR) (Additional file 1: Table S1) [24, 58]
The study cohort of hip fracture patients were representative of a typical hip fracture patient population, with a mean age of 82.9 (±7.5) and 64.6 % over the age Statistical analyses Statistical differences in hip fracture patient characteristics between health regions and immediate discharge destinations were determined using Chi-Square tests, Fisher’s exact test, or Analysis of variance
Summary
Hip fractures among older adults are one of the leading causes of hospitalization and result in significant morbidity, mortality, and health care use. Post-acute care (which encompasses rehabilitation) is currently delivered in a multitude of settings, and there is a lack of evidence with regards to which hip fracture patients should use which post-acute settings. The purpose of this study is to describe hip fracture patient characteristics and the most common post-acute pathways within a 1-year episode of care, and to examine how these vary regionally within a health system. Hip fractures result in extensive morbidity, mortality, and health care use. Between 30 and 50 % of patients do not return to their pre-morbid function even two years post-fracture and estimates of attributable mortality rates 1 year post-fracture range between 20 and 30 % [10, 15,16,17]. From a Canadian health system perspective, 1-year attributable health-care cost of hip fractures is $1.1 billion [15]
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