title: Effect of inpatient quality of care on functional outcomes in patients with hip fracture.
abstract: OBJECTIVE
  We sought to examine the relationship between functional outcome and process of care for patients with hip fracture.
  
  
  METHODS
  We undertook a prospective cohort study in 4 hospitals of 554 patients treated with surgery for hip fracture.
  
  
  METHODS
  Information on patient characteristics and processes of hospital care collected from the medical record, interviews, and bedside observations. Follow-up information obtained at 6 months on function (using the Functional Independence Measure [FIM]), survival, and readmission.
  
  
  RESULTS
  Individual processes of care were generally not associated with adjusted outcomes. A scale of 9 processes related to mobilization was associated with improved adjusted locomotion (P = 0.006), self care (P = 0.022), and transferring (P = 0.007) at 2 months, but the benefits were smaller and not significant by 6 months. These processes were not associated with mortality. The predicted value for the FIM locomotion measure (range, 2-14) at 2 months was 5.9 (95% confidence interval 5.4-6.4) for patients at the 10th percentile of performance on these processes compared with 7.1 (95% confidence interval 6.6, 7.6) at the 90th percentile. Patients who experienced no hospital complications and no readmissions retained the benefits in locomotion at 6 months. Anticoagulation processes were associated with improved transferring at 2 months (P = 0.046) but anticoagulation and other processes of care were not otherwise associated with improved function.
  
  
  CONCLUSIONS
  Our findings indicate the need to attend to all steps in the care of patients with hip fracture. Additionally, functional outcomes were more sensitive markers of improved process of care, compared with 6-month mortality, in the case of hip fracture.
authors.affiliation: Mount Sinai School of Medicine, New York, New York 10029, USA. albert.siu@mssm.edu
authors.forename: Albert L
authors.initials: AL
authors.lastname: Siu
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Boockvar
authors.forename: Joan D
authors.initials: JD
authors.lastname: Penrod
authors.forename: R Sean
authors.initials: RS
authors.lastname: Morrison
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
authors.forename: Ann
authors.initials: A
authors.lastname: Litke
authors.forename: Stacey B
authors.initials: SB
authors.lastname: Silberzweig
authors.forename: Jeanne
authors.initials: J
authors.lastname: Teresi
authors.forename: Katja
authors.initials: K
authors.lastname: Ocepek-Welikson
authors.forename: Jay
authors.initials: J
authors.lastname: Magaziner
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D006304:Health Status; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007297:Inpatients; D008297:Male; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D016896:Treatment Outcome