Development and validation of a clinical prediction rule for prolonged nursing home residence after hip fracture.
OBJECTIVE
To develop and validate a clinical prediction rule for nursing home residence 6 months after a hip fracture.


METHODS
Two prospective cohort studies, a development study (DS) and a validation study (VS).


METHODS
The DS included hip fracture patients admitted to 92 rehabilitation units or skilled nursing facilities; the VS included hip fracture patients from 11 integrated healthcare systems.


METHODS
A total of 344 community-dwelling hip fracture patients aged 65 and older participated in the DS; 239 similar patients were enrolled in the VS.


METHODS
None.


METHODS
The acute hospital record, nursing evaluations, and patient questionnaires provided information about demographics, physical and neuropsychological function, and comorbidity. Residence 6 months after fracture was determined by phone interview. Multivariate analysis identified predictors for a risk score to assess the likelihood of nursing home residence.


RESULTS
18.7% of patients in the DS resided in nursing homes 6 months after hip fracture. The four independent risk factors for institutionalization were (1) being unmarried (OR = 6.7 [95% CI 2.4 to 19]), (2) incontinence (OR = 2.3 [CI 1.2 to 4.7]), (3) dependence in ambulation (OR = 5.0 [CI 2.1 to 12.3]), and (4) cognitive impairment (OR = 6.6 [CI 3.3 to 13.2]). Of patients with all four risk factors, 73.2% were institutionalized at 6 months, compared with 0% of patients with no risk factors. In the VS, 6.1% of patients resided in nursing homes after 6 months, with a range from 50.0% of patients with four risk factors to 0% of those with no risk factors. Areas under receiver-operating characteristic curves for the prediction rule were 0.84 +/- .03 in the DS, and 0.81 +/- .06 in the VS.


CONCLUSIONS
A clinical prediction rule using four easily measurable characteristics can identify individuals at high or low risk of nursing home residence 6 months after hip fracture.
Steiner
J F
JF
Center for Health Services Research, University of Colorado Health Sciences Center, Denver, USA.
Kramer
A M
AM
Eilertsen
T B
TB
Kowalsky
J C
JC
D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders; D005260:Female; D015577:Geriatric Assessment; D006620:Hip Fractures; D006801:Humans; D007902:Length of Stay; D008297:Male; D017533:Marital Status; D015999:Multivariate Analysis; D009735:Nursing Homes; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D014549:Urinary Incontinence; D016138:Walking