Proportion Of Health Care Costs Research Articles

The Golden Patient Initiative: A Systematic Review.

Operating theatres and surgical resource consumption comprise a significant proportion ofhealthcare costs. Inefficiencies in theatre lists remain an important focus for cost management, along with reducing patient morbidity and mortality. With the emergence of the coronavirus disease 2019 (COVID-19) pandemic, the number of patients on theatre waiting lists has surged. Hence, there is a pressing need to utilise the already limited theatre time and fraught resources with innovative methods. In this systematic review, we discuss the Golden Patient Initiative (GPI), in which the first patient on the operating list is pre-assessed the day prior to surgery, and we aim to assess its impact and overall efficacy. A literature search using the following four databases was conducted to identify and select all clinical research concerning the GPI: Medical Literature Analysis and Retrieval System Online (MEDLINE),Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (EMBASE), and the Cochrane library. Two independent authors screened articles against the eligibility criteria, using a process adapted from the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Data extracted included outcomes measured, follow-up period, and study design. The results showed significant heterogeneity, and hence a narrative review was conducted; 13 of the 73 eligible articles were included for analysis. Outcomes included delay in theatre start time, number of surgical case cancellations, and changes to total case numbers. Across the studies, a 19-30-minute improvement in theatre start time was reported (p<0.05), as well as a statistically significant decrease in case cancellations. Our analysis provides encouraging conclusions with regard to greater theatre efficiency following the application of GPI, a low-cost solution that can easily be implemented to help improve patient safety and lead to cost savings. However, at present, it is largely implemented amonglocal trusts, and hence larger multi-centre studies are required to gather conclusive evidence about the efficacy of the initiative.

Use of Remote Cardiorespiratory Monitoring is Associated with a Reduction in Hospitalizations for Subjects with COPD.

Chronic obstructive pulmonary disease (COPD) is prevalent and results in high healthcare resource utilization. The largest impact on health status and proportion of healthcare costs in COPD are related to hospitalizations for acute exacerbations. Accordingly, the Centers for Medicare & Medicaid Services have advocated for remote patient monitoring (RPM) to aid in chronic disease management. However, there has been a lack of evidence for the effectiveness of RPM in reducing the need for unplanned hospitalizations for patients with COPD. This pre/post study was a retrospective analysis of unplanned hospitalizations in a cohort of COPD subjects started on RPM at a large, outpatient pulmonary practice. The study included all subjects with at least one unplanned, all-cause hospitalization or emergency room visit in the prior year, who had elected to enroll in an RPM service for assistance with clinical management. Additional inclusion criteria included being on RPM for at least 12 months and a patient of the practice for at least two years (12 months pre- and post-initiation of RPM). The study included 126 subjects. RPM was associated with a significantly lower rate of unplanned hospitalizations per patient per year (1.09 ± 0.07 versus 0.38 ± 0.06, P<0.001). Unplanned, all-cause hospitalization rates were lower in subjects started on RPM for COPD when compared to their prior year. These results support the potential of RPM to improve the long-term management of COPD.

Identifying Homogeneous Patient Clusters in Swiss University Hospital Through Latent Class Analysis.

In hospitalized populations, there is significant heterogeneity in patients' characteristics, disease severity, and treatment responses, which translates into different related outcomes and costs. Identifying inpatient clusters with similar clinical profiles could lead to better quality and personalized care while improving clinical resources used. Super-utilizers (SUs) are one such a group, who contribute a substantial proportion of health care costs and utilize a disproportionately high share of health care resources. This study uses cost, utilization metrics and clinical information to segment the population of patients (N=32,759) admitted to the University Hospitals of Geneva per year in 2017 - 2019. Using Latent Class Analysis it identifies 8 subgroups with highly similar patients demographics, medical conditions, types of service and costs within groups and which are highly different between groups. As such 82% of all SU patients, 99% of all patients less than 20 years old and 78% of all orthopedics patients are clustered into only 3 separate groups while one group contain only adult women 90% of them 20 to 40 years of age.

Current and lifetime somatic symptom burden among transition-aged autistic young adults.

Somatic symptoms are the most common cause of outpatient medical visits in the general population, yet their presence and severity in individuals on the autism spectrum has rarely been studied. We sought to assess the prevalence, impact, and clinical correlates of 14 commonly reported somatic symptoms in a sample of 290 transition-aged autistic young adults (mean [SD] age: 23.10 [2.38] years, range 18-26; 76.7% diagnosed with autism before age 18) recruited from the Simons Foundation SPARK participant pool. A modified version of the Patient Health Questionnaire-15 was used to assess somatic symptom prevalence/impact, along with measures of depression, anxiety, autistic traits, and quality of life. Somatic symptom burden was much higher in autistic young adults than previously reported in the general population. The most commonly reported current symptoms were fatigue (72.8%), sleep problems (69.0%), and menstrual problems (61.4% of females). Moderate or severe symptom levels were reported by 53.9% of females and 18.75% of males in our cohort, with the odds of females endorsing any given symptom being 2-4 times greater than males. Both individual symptoms and total symptom burden were related to higher levels of depression, anxiety, and autistic traits, along with lower quality of life. Despite little research on this topic previously, somatic symptoms are highly prevalent in autistic young adults, particularly women. Future research is needed to investigate links between somatic symptoms, medical and psychiatric morbidity, and health care utilization in the autistic population. LAY SUMMARY: Somatic symptoms (i.e., physical symptoms such as such as pain, weakness, stomachache, or shortness of breath) are highly prevalent in the general population and account for a large proportion of health care costs. However, few studies have investigated how often these symptoms are reported by autistic adults or their associations with other clinical and demographic variables. Based on self-report data from 290 young autistic adults, we found very high rates of bothersome somatic symptoms in this population, with females endorsing all symptoms at substantially higher rates than males. Somatic symptoms were also associated with worse mental health and quality of life, suggesting that they represent an overlooked contributor to poor health outcomes in the autistic adult population.

Use of Latent Class Analysis and k-Means Clustering to Identify Complex Patient Profiles

Medically complex patients are a heterogeneous group that contribute to a substantial proportion of health care costs. Coordinated efforts to improve care and reduce costs for this patient population have had limited success to date. To define distinct patient clinical profiles among the most medically complex patients through clinical interpretation of analytically derived patient clusters. This cohort study analyzed the most medically complex patients within Kaiser Permanente Northern California, a large integrated health care delivery system, based on comorbidity score, prior emergency department admissions, and predicted likelihood of hospitalization, from July 18, 2018, to July 15, 2019. From a starting point of over 5000 clinical variables, we used both clinical judgment and analytic methods to reduce to the 97 most informative covariates. Patients were then grouped using 2 methods (latent class analysis, generalized low-rank models, with k-means clustering). Results were interpreted by a panel of clinical stakeholders to define clinically meaningful patient profiles. Complex patient profiles, 1-year health care utilization, and mortality outcomes by profile. The analysis included 104 869 individuals representing 3.3% of the adult population (mean [SD] age, 70.7 [14.5] years; 52.4% women; 39% non-White race/ethnicity). Latent class analysis resulted in a 7-class solution. Stakeholders defined the following complex patient profiles (prevalence): high acuity (9.4%), older patients with cardiovascular complications (15.9%), frail elderly (12.5%), pain management (12.3%), psychiatric illness (12.0%), cancer treatment (7.6%), and less engaged (27%). Patients in these groups had significantly different 1-year mortality rates (ranging from 3.0% for psychiatric illness profile to 23.4% for frail elderly profile; risk ratio, 7.9 [95% CI, 7.1-8.8], P < .001). Repeating the analysis using k-means clustering resulted in qualitatively similar groupings. Each clinical profile suggested a distinct collaborative care strategy to optimize management. The findings suggest that highly medically complex patient populations may be categorized into distinct patient profiles that are amenable to varying strategies for resource allocation and coordinated care interventions.

Imaging Appropriateness for Neck Pain.

Imaging of neck pain contributes to a significant proportion of health care costs and is expected to increase with current practices that heavily use radiologic studies as a diagnostic tool. Though consensus guidelines are available to assist physicians in selection of appropriate imaging examinations for neck pain, it is unclear if current ordering practices reflect their use and understanding. To investigate this, we analyzed the number and types of imaging examinations performed for neck pain at a university medical center over the past year. Current trends at our institution suggest that clinicians use consensus imaging guidelines, but there is still controversy in the cervical spine for when not to image. To promote appropriate imaging utilization, we developed an algorithm to guide imaging of neck pain, based upon clinical presentation, referral patterns for neck pain, and a review of the literature.

Economic Burden of Anxiety Disorders: A Systematic Review and Meta-Analysis.

Anxiety disorders (AD) are common mental disorders, for which several cost-of-illness (COI) studies have been conducted in the past. The aim of this review was to provide a systematic overview of these studies and an aggregation of their results. A systematic literature search limited to studies published after 1999 was conducted in PubMed/MEDLINE in November 2018. We included top-down COI studies reporting costs for AD, and bottom-up COI studies reporting costs for AD and a non-diseased control group, and extracted data manually. Results of the top-down COI studies were aggregated by calculating the mean percentage of costs on gross domestic product (GDP) and health expenditure, while the results of the bottom-up studies were analyzed meta-analytically using the 'ratio of means' method and inverse-variance pooling. In this review, the logarithm of the relative difference in a continuous outcome between two groups is calculated and aggregated over the studies. The results can be interpreted as the relative change in costs imposed by a specific disease compared with baseline costs. We identified 13 top-down and 11 bottom-up COI studies. All top-down COI studies and four bottom-up COI studies reported costs for AD as a diagnostic group, four for generalized anxiety disorder (GAD), four for social anxiety disorder (SAD), and one for panic disorder. In top-down COI studies, direct costs of AD, on average, corresponded to 2.08% of health care costs and 0.22% of GDP, whereas indirect costs, on average, corresponded to 0.23% of GDP. In bottom-up COI studies, direct costs of patients with AD were increased by factor 2.17 (1.29-3.67; p=0.004) and indirect costs were increased by factor 1.92 (1.05-3.53; p=0.04), whereas total costs increased by factor 2.52 (1.73-3.68; p<0.001). Subgroup analysis revealed an increase in direct costs by 1.60 (1.16-2.22; p=0.005) for SAD and 2.60 (2.01-3.36; p<0.001) for GAD. Measures of heterogeneity indicated high heterogeneity when pooling studies for direct costs, indirect costs, and total costs, but low to moderate heterogeneity when pooling studies for SAD or GAD. Using methods that focused on relative rather than absolute costs, we were able to aggregate costs reported in different COI studies for ADs. We found that ADs were associated with a low proportion of health care costs on a population level, but significantly increased health care costs on an individual level compared with healthy controls. Our disorder-specific subgroup analysis showed that study findings are most homogeneous within specific ADs. Therefore, to get a more detailed picture of the costs of ADs, more studies for currently under researched ADs, such as panic disorder, are needed.

Depression predicts emergency care use in people with chronic obstructive pulmonary disease: a large cohort study in primary care.

Background: Depression is common in people with chronic obstructive pulmonary disease (COPD) and has been associated with a variety of poor outcomes. A large proportion of health care costs in the UK are spent on emergency care. This study examined the prospective relationship between depression and use of emergency care in patients with COPD managed in primary care.Methods: This was a twelve-month, prospective longitudinal study of 355 patients with COPD in six primary care practices in the UK. Baseline measures included demographic characteristics, depression and anxiety, severity of COPD, presence or absence of other chronic diseases, and prior use of emergency care. Outcome measures were (a) number of emergency department (ED) visits; or (b) an emergency hospital admission in the follow-up year.Results: Older age, number of comorbid physical health conditions, severity of COPD, prior use of emergency care, and depression were all independently associated with both ED attendance and an emergency hospital admission in the follow-up year. Subthreshold depression (HADS depression score 4–7) was associated with a 2.8 times increased odds of emergency hospital admission, and HADS depression >8 was associated with 4.8 times increased odds.Conclusion: Depression is a predictor of emergency care in COPD, independent of severity of disease or physical comorbidity. Even mild (subthreshold) symptoms of depression more than double the risk of using emergency care, suggesting there is a strong case to develop and deploy integrated preventive strategies in primary care that can promote mental health in people with COPD.

Determining preventable acute care spending among high-cost patients in a single-payer public health care system.

Research has shown that a small proportion of patients account for the majority of health care spending. The objective of this analysis was to determine the amount and proportion of preventable acute care spending among high-cost patients. We examined a population-based sample of all adult high-cost patients using linked administrative health care data housed at ICES in Toronto, Ontario. High-cost patients were defined as those in and abovethe 90th percentile of the cost distribution. Preventable acute care (emergency department visits and hospitalisations) was defined using validated algorithms. We estimated costs of preventable and non-preventable acute care for high- and non-high-cost patients by category of visit/condition. We replicated our analysis for persistent high-cost patients and high-cost patients under 65years and those 65years and older. We found that 10% of all acute care spending among high-cost patients was considered preventable; this figure was higher for non-high-cost patients (25%). The proportion of preventable acute care spending was higher for persistent high-cost patients (14%) and those 65years and older (12%). Among ED visits, the largest portion of preventable care spending was for primary care treatable conditions; for hospitalisations, the highest proportions of preventable care spending were for COPD, bacterial pneumonia and urinary tract infections. Although high-cost patients account for a substantial proportion of health care costs, there seems to be limited scope to prevent acute care spending among this patient population. Nonetheless, care coordination and improved access to primary care, and disease prevention may prevent some acute care.

A Quest for Optimization of Postoperative Triage After Major Surgery.

Innovative strategies to reduce costs while maintaining patient satisfaction and improving delivery of care are greatly needed in the setting of rapidly rising health care expenditure. Intensive care units (ICUs) represent a significant proportion of health care costs due to their high resources utilization. Currently, the decision to admit a patient to the ICU lacks standardization because of the lack of evidence-based admission criteria. The objective of our research is to develop a prediction model that can help the physician in the clinical decision-making of postoperative triage. Our group identified a list of index events that commonly grants admission to the ICU independently of the hospital system. We analyzed correlation among 200 quantitative and semiquantitative variables for each patient in the study using a decision tree modeling (DTM). In addition, we validated the DTM against explanatory models, such as bivariate analysis, multiple logistic regression, and least absolute shrinkage and selection operator. Unlike explanatory modeling, DTM has several unique strengths: tree models are easy to interpret, the analysis can examine hundreds of variables at once, and offer insight into variable relative importance. In a retrospective analysis, we found that DTM was more accurate at predicting need for intensive care compared with current clinical practice. DTM and predictive modeling may enhance postoperative triage decision-making. Future areas of research include larger retrospective analyses and prospective observational studies that can lead to an improved clinical practice and better resources utilization.

Which Complex Patients Should Be Referred for Intensive Care Management? A Mixed-Methods Analysis.

A large and increasing proportion of health care costs are spent caring for a small segment of medically and socially complex patients. To date, it has been difficult to identify which patients are best served by intensive care management. To characterize factors that best identify which complex patients are most suited for intensive care management. We conducted a mixed-methods study involving 35 care managers (CMs; 10 licensed social workers and 25 registered nurses) working in intensive care management programs within Kaiser Permanente Northern California (KPNC) outpatient medical centers. We asked CMs to review a randomly selected list of up to 50 patients referred to them in the prior year and to categorize each patient as either (1) "good candidates" for care management, (2) "not needing" intensive care management, or (3) "needing more" than traditional care management could provide. We then conducted semi-structured interviews to understand how CMs separated patients into these three groups. CMs assigned 1178 patients into the 3 referral categories. Less than two thirds (62%, n = 736) of referred patients were considered good candidates, with 18% (n = 216) categorized as not needing care management and 19% (n = 226) as needing more. Compared to the other two categories, good candidates were older (76.2years vs. 73.2 for not needing and 69.8 for needing more, p < 0.001), prescribed more medications (p = 0.02) and had more prior year outpatient visits (p = 0.04), while the number of prior year hospital and emergency room admissions were greater than not needing but less than needing more (p < 0.001). A logistic regression model using available electronic record data predicted good candidate designation with a c statistic of 0.75. Several qualitative themes emerged that helped define appropriateness for referral, including availability of social support, patient motivation, non-medical transitions, recent trajectory of medical condition, and psychiatric or substance use issues. Many apparently complex patients are not good candidates for intensive care management. Current electronic medical records do not capture several of the most salient characteristics that determine appropriateness for care management. Our findings suggest that systematic collection of social support, patient motivation, and recent non-medically related life change information may help identify which complex patients are most likely to benefit from care management.

Healthcare utilization in older patients using personal emergency response systems: an analysis of electronic health records and medical alert data

BackgroundPersonal Emergency Response Systems (PERS) are traditionally used as fall alert systems for older adults, a population that contributes an overwhelming proportion of healthcare costs in the United States. Previous studies focused mainly on qualitative evaluations of PERS without a longitudinal quantitative evaluation of healthcare utilization in users. To address this gap and better understand the needs of older patients on PERS, we analyzed longitudinal healthcare utilization trends in patients using PERS through the home care management service of a large healthcare organization.MethodsRetrospective, longitudinal analyses of healthcare and PERS utilization records of older patients over a 5-years period from 2011–2015. The primary outcome was to characterize the healthcare utilization of PERS patients. This outcome was assessed by 30-, 90-, and 180-day readmission rates, frequency of principal admitting diagnoses, and prevalence of conditions leading to potentially avoidable admissions based on Centers for Medicare and Medicaid Services classification criteria.ResultsThe overall 30-day readmission rate was 14.2%, 90-days readmission rate was 34.4%, and 180-days readmission rate was 42.2%. While 30-day readmission rates did not increase significantly (p = 0.16) over the study period, 90-days (p = 0.03) and 180-days (p = 0.04) readmission rates did increase significantly. The top 5 most frequent principal diagnoses for inpatient admissions included congestive heart failure (5.7%), chronic obstructive pulmonary disease (4.6%), dysrhythmias (4.3%), septicemia (4.1%), and pneumonia (4.1%). Additionally, 21% of all admissions were due to conditions leading to potentially avoidable admissions in either institutional or non-institutional settings (16% in institutional settings only).ConclusionsChronic medical conditions account for the majority of healthcare utilization in older patients using PERS. Results suggest that PERS data combined with electronic medical records data can provide useful insights that can be used to improve health outcomes in older patients.

Commitment Devices

Unhealthy behaviors are responsible for a large proportion of health care costs and poor health outcomes.1 Surveys of large employers regularly identify unhealthy behaviors as the most important challenge to affordable benefits coverage. For this reason, employers increasingly leverage incentives to encourage changes in employees’ health-related behaviors. According to one survey, 81% of large employers provide incentives for healthy behavior change.2 In this Viewpoint, we discuss the potential and limitations of an approach that behavioral science research has shown can be used to influence health behaviors but that is distinct from incentives: the use of commitment devices (Table).3

Effect of multiple chronic diseases on health care expenditures in childhood.

To examine multiple chronic conditions and related health care expenditures in children. Retrospective cohort study of all dependents of Mayo Clinic employees aged 0-17 on Jan 1, 2004 with continuous health benefits coverage for 4 years (N=14,727). Chronic conditions, health care utilization, and associated expenditures were obtained from medical and pharmacy claims. The most prevalent chronic conditions were asthma/chronic obstructive pulmonary disease (12%), allergic rhinitis (11%), and behavior problems (9%). The most costly conditions were congenital anomalies, asthma/chronic obstructive pulmonary disease, and behavior problems ($9602, $4335, and $5378 annual cost per child, respectively). Annual health care expenditures increased substantially with the number of chronic conditions, and a small proportion of children with multiple chronic conditions accounted for a large proportion of health care costs. In addition, those with multiple chronic conditions were more likely to persist in the top 10th percentile spender group in year-to-year spending. Children with multiple chronic conditions accounted for a large proportion of health care expenditures. These children were also likely to persist as high spenders in the 4-year time frame. Further research into effective ways to manage the health care delivery for children with multiple chronic conditions is needed.

Commitment devices: using initiatives to change behavior.

Unhealthy behaviors are responsible for a large proportion of health care costs and poor health outcomes.1 Surveys of large employers regularly identify unhealthy behaviors as the most important challenge to affordable benefits coverage. For this reason, employers increasingly leverage incentives to encourage changes in employees’ health-related behaviors. According to one survey, 81% of large employers provide incentives for healthy behavior change.2 In this Viewpoint, we discuss the potential and limitations of an approach that behavioral science research has shown can be used to influence health behaviors but that is distinct from incentives: the use of commitment devices (Table).3

Delineation of House Design Guidelines for Fall Prevention of Older People

As the average life span becomes longer due to the development of medical technology and improving living conditions, interest in the quality of life in old age is on the increase. Health is central to a better quality of life, but the increasing healthcare costs incurred by older people are expected to become a heavy burden on society. Falls are the main external cause of unintentional injury among older people and are also responsible for a large proportion of healthcare costs. They occur frequently in the home and this has necessitated the improvement of the home environment in relation to fall prevention. Although there have been a considerable amount of studies concerning design features and guidelines, not enough research about the relationship between fall risks and the home environment has been conducted. In this context, the purpose of this study is to delineate house design guidelines for fall prevention in a comprehensive and systematic way. The main method of this study is a content analysis technique, and thirteen sources related to the environmental design for fall prevention and universal design were analysed through the content analysis. As a result, a total of 220 guidelines for fall prevention were identified and systematically arranged according to fall risk factors. These guidelines will help older people better perceive the danger of falls and will promote the improvement of housing conditions based on fall risk factors.

SAT0305 Costs of Best Supportive Care in the Treatment of Moderate-To-Severe Psoriatic Arthritis in the United States

BackgroundPsoriatic arthritis (PsA) is an inflammatory condition of the joints that occurs in up to 30% of patients with psoriasis. While the cost of DMARD therapy has previously been described,...

Randomized controlled trial of feedback on cost of hospital care among gastroenterology inpatients

Spending on hospital inpatients comprises a major proportion of healthcare costs. This study assessed the impact of systematic feedback to gastroenterologists on the cost of care provided to inpatients on a gastrointestinal/hepatology (GIH) hospital service. Patients with a GIH diagnosis were randomly assigned to be cared for by one of two hospital services. Over 3 months, teams were randomized to receive feedback (GIH A) or no feedback (GIH B, control group); feedback consisted of an email sent twice weekly to all physicians on the GIH A service detailing the length of stay (LOS) and real-time cost of care accrued by each inpatient. Over 3 months, care was provided to 56 (GIH A) and 47 (GIH B) inpatients with a GIH illness. Patient complexity level was similar for both services as demonstrated by mean relative value: 1.11 (GIH A) vs. 1.27 (GIH B), p=0.2. Weighted LOS and weighted cost of care values were calculated to adjust for the respective RV of each patient. Mean weighted LOS (10.8 [GIH A] vs. 13.8 days/pt [GIH B], p=0.02) and mean weighted cost of care (9,904 [GIH A] vs. 12,654 euros/pt [GIH B], p=0.02) were significantly lower in the feedback group. Subsequent hospital readmission rates did not differ among both groups. Systematic feedback on cost of care was associated with lower healthcare costs without compromising quality. Incorporating a running total of patient costs into computer software used to order patient tests may represent one approach to controlling healthcare expenses.

Patterns and Costs of Health Care Use of Children With Medical Complexity

Health care use of children with medical complexity (CMC), such as those with neurologic impairment or other complex chronic conditions (CCCs) and those with technology assistance (TA), is not well understood. The objective of the study was to evaluate health care utilization and costs in a population-based sample of CMC in Ontario, Canada. Hospital discharge data from 2005 through 2007 identified CMC. Complete health system use and costs were analyzed over the subsequent 2-year period. The study identified 15 771 hospitalized CMC (0.67% of children in Ontario); 10 340 (65.6%) had single-organ CCC, 1063 (6.7%) multiorgan CCC, 4368 (27.6%) neurologic impairment, and 1863 (11.8%) had TA. CMC saw a median of 13 outpatient physicians and 6 distinct subspecialists. Thirty-six percent received home care services. Thirty-day readmission varied from 12.6% (single CCC without TA) to 23.7% (multiple CCC with TA). CMC accounted for almost one-third of child health spending. Rehospitalization accounted for the largest proportion of subsequent costs (27.2%), followed by home care (11.3%) and physician services (6.0%). Home care costs were a much larger proportion of costs in children with TA. Children with multiple CCC with TA had costs 3.5 times higher than children with a single CCC without TA. Although a small proportion of the population, CMC account for a substantial proportion of health care costs. CMC make multiple transitions across providers and care settings and CMC with TA have higher costs and home care use. Initiatives to improve their health outcomes and decrease costs need to focus on the entire continuum of care.

Objective sound wave amplitude measurement generated by a tuning fork. An analysis of its use as a diagnostic tool in suspected femoral neck fractures

IntroductionHip injuries are becoming a more common problem as the elderly population increases and their management represents a significant proportion of health care costs. Diagnosis of a fracture based on clinical assessment and plain films is not always conclusive and further investigations for such occult fractures, such as magnetic resonance imaging (MRI), are sometimes required which are expensive and may be difficult to access. Disruption to the conduction of a sound wave travelling through a fractured bone is a concept that has been used to diagnose fractures. Patients and methodsIn our study we used a tuning fork with frequency of 128Hz to objectively measure the reduction in sound amplitude in fractured and non-fractured hips. We looked at the feasibility of using this test as a diagnostic tool for neck of femur fractures. ResultsA total of 20 patients was included in the study, using MRI scan as the standard for comparison of diagnostic findings. Informed consent was obtained from the patients. There was a significant difference in the amplitude reduction of the sound waves when comparing normal to fractured hips. This was 0.9 in normal hips, compared to 0.31 and 0.18 in intra-capsular and extra-capsular fractures, respectively. Our test was 80% accurate at diagnosing neck of femur fractures. ConclusionIn conclusion this test may be used as a diagnostic test or screening tool in the assessment of occult hip fractures.