title: Early discharge of hip fracture patients from hospital: transfer of costs from hospital to nursing home.
abstract: Hip fracture patients occupy more and more hospital beds. One of the strategies for coping with this problem is early discharge from the hospital to institutions with rehabilitation facilities. We studied whether early discharge affects outcome and costs. 208 elderly patients with a hip fracture were followed up to 4 months after the fracture. First, a group of 102 patients stayed in our hospital for the usual period (median 18 days). Then, 106 patients were assigned to a group for early discharge (median 11 days). We measured disabilities, health-related quality of life and cognition at 1 week, 1, and 4 months after hospitalization. To calculate total societal costs, inpatient days, the efforts of professionals in- and outside institutions, and interventions/examinations were recorded during this 4-month period. At 4 months, we found no differences in mortality, ADL level, complications, quality of life, and type of residence. More patients in the early discharge group were discharged to nursing homes with rehabilitation facilities (76% versus 53%), but the median total stay in hospital and nursing home was the same (26 days). Early discharge from hospital did not substantially reduce the total costs (conventional management Euro 15,338 per patient and early discharge Euro 14,281 per patient), but merely shifted them from the hospital to the nursing home.
authors.affiliation: Geriatric Centre and Nursing Home Antonius Binnenweg, Rotterdam, The Netherlands. R.van Balen@kvv.nl
authors.forename: Romke
authors.initials: R
authors.lastname: van Balen
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Herman J M
authors.initials: HJ
authors.lastname: Cools
authors.forename: Johan J
authors.initials: JJ
authors.lastname: Polder
authors.forename: J Dik F
authors.initials: JD
authors.lastname: Habbema
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006620:Hip Fractures / Q000191:economics* / Q000534:rehabilitation*; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D009735:Nursing Homes / Q000191:economics*; D017063:Outcome Assessment, Health Care / Q000191:economics; D010351:Patient Discharge / Q000191:economics*; D011446:Prospective Studies; D011788:Quality of Life; D013997:Time Factors