All-cause mortality rates of hip fractures treated in the VHA: do they differ from Medicare facilities?
OBJECTIVE
To estimate the 1-year all-cause mortality rates for hip fracture (HFx) patients hospitalized at Veterans Health Administration (VHA) facilities and compare with previous published mortality rates for veterans treated in Medicare facilities.


METHODS
In total, 7 years of VHA discharge data on HFxs for 12,539 patients age 65 and older were combined with national death registry data. We performed a 1-year survival analysis using the Cox proportional hazard method.


RESULTS
The adjusted rates for veterans treated in the VHA (30 days=9.3%, 90 days=17.5%, 180 days=23.3%, 365 days=29.8%) were similar to veterans treated in Medicare facilities (30 days=8.9%, 90 days=15.6%, 180 days=21.8%, 365 days=29.9%). For veterans treated for a HFx in Medicare facilities, the average length of stay was 7 days and 49% were discharged to a nursing home. Veterans treated in the VHA had an average length of stay of 14 days and only 35% were discharged to a nursing home.


CONCLUSIONS
Our study suggests no difference in HFx-adjusted mortality rates between the VHA and Medicare facilities. Given the institutional factor differences between Medicare and the VHA, future study and comparison of health outcomes for nursing home HFx patients and related costs between these two health care programs may contribute to the on-going health care reform debate.
Lapcevic
William A
WA
HSR&D/RR&D Research Center of Excellence, Maximizing Rehabilitation Outcomes, Tampa, FL, USA.
French
Dustin D
DD
Campbell
Robert R
RR
D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005260:Female; D006620:Hip Fractures / Q000401:mortality*; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D006278:Medicare; D016016:Proportional Hazards Models; D012042:Registries; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology