Effect of fracture on the health care use of nursing home residents.
BACKGROUND
Osteoporotic fractures result in increased health care use. Care following fracture has been characterized for community dwellers but not for nursing home residents, whose fracture rates are as much as 11 times higher than those of age-matched community dwellers. Knowing the amount of care following fracture may help determine the effects of fracture prevention on use and costs in this population.


METHODS
A prospective cohort study was conducted, with 18 months of follow-up, of 1427 randomly selected white, female nursing home residents 65 years and older from 47 randomly selected nursing homes in Maryland.


RESULTS
After controlling for age, comorbidities, and mobility, nursing home residents who experienced a fracture were hospitalized more than 15 times as often as those who did not in the month following the fracture (relative rate, 15.35; 95% confidence interval, 12.27-19.21) and at a higher rate from 3 through 12 months postfracture. Rates in the first month were higher for persons with a hip fracture (relative rate, 31.01; 95% confidence interval, 26.52-36.24). Rates of emergency department use and contacts with physicians and therapists were increased, the latter two for 12 months following fracture. Also, before the fracture, patients who experienced a fracture visited the emergency department and had more physician contacts; for those with a hip fracture, there were fewer prefracture hospitalizations.


CONCLUSIONS
Health care use remained elevated through 1 year postfracture. Comparisons with community patients suggest that this care may be less than what would be provided in other settings. For patients who fractured a hip, higher use decreased after 6 months, similar to community cohorts. Nursing home residents who visit the emergency department may warrant special screening for a fracture.
Zimmerman
Sheryl
S
Cecil G. Sheps Center for Health Services Research, the School of Social Work, University of North Carolina at Chapel Hill, 27599-3386, USA.
Chandler
Julie M
JM
Hawkes
William
W
Sloane
Philip D
PD
Hebel
J Richard
JR
Magaziner
Jay
J
Martin
Allison R
AR
Girman
Cynthia J
CJ
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050723:Fractures, Bone / Q000209:etiology; D006295:Health Resources / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008396:Maryland; D009735:Nursing Homes / Q000706:statistics & numerical data*; D015663:Osteoporosis, Postmenopausal / Q000150:complications; D013997:Time Factors