Health services utilization after fractures: evidence from Medicare.
BACKGROUND
Osteoporosis-related fractures impose a large and growing societal burden, including adverse health effects and direct medical costs. Postfracture utilization of health care services represents an alternative measure of the resource costs associated with these fractures.


METHODS
We use a 5% random sample of Medicare claims data to construct annual cohorts (2000-2004) of beneficiaries diagnosed with incident fractures at one of seven sites--clinical vertebral, hip pelvis, femur, tibia/fibula, humerus, and distal radius/ulna. We use person-specific changes in health services utilization (eg, inpatient acute/postacute days, home health visits, physical, and occupational therapy) before/after fractures and probabilities of entry into (long-term) nursing home residency to estimate the utilization burden associated with fractures.


RESULTS
Relative to the prior 6-month period, rates of acute hospitalization are between 19.5 (distal radius/ulna) and 72.4 (hip) percentage points higher in the 6 months after fractures. Average acute inpatient days are 1.9 (distal radius/ulna) to 8.7 (hip) higher in the postfracture period. Fractures are associated with large increases in all forms of postacute care, including postacute hospitalizations (13.1-71.5 percentage points), postacute inpatient days (6.1-31.4), home health care hours (3.4-8.4), and hours of physical (5.2-23.6) and occupational (4.3-14.0) therapy. Among patients who were community dwelling at the time of the initial fracture, 0.9%-1.1% (2.4%-4.0%) were living in a nursing home 6 months (1 year) after the fracture.


CONCLUSIONS
Fractures are associated with significant increases in health services utilization relative to prefracture levels. Additional research is needed to assess the determinants and effectiveness of alternative forms of fracture care.
Department of Health Care Organization and Policy, University of Alabama at Birmingham, 1665 University Blvd., RPHB 330H, Birmingham, AL 35294, USA. dbecker@uab.edu
David J
DJ
Becker
Huifeng
H
Yun
Meredith L
ML
Kilgore
Jeffrey R
JR
Curtis
Elizabeth
E
Delzell
Lisa C
LC
Gary
Kenneth G
KG
Saag
Michael A
MA
Morrisey
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D018574:Home Care Agencies / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare; D009735:Nursing Homes / Q000706:statistics & numerical data; D009788:Occupational Therapy / Q000706:statistics & numerical data; D010024:Osteoporosis / Q000453:epidemiology*; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D014481:United States