title: The direct cost of acute hip fracture care in care home residents in the UK.
abstract: Data on the true acute care costs of hip fractures for patients admitted from care homes are limited. Detailed costing analysis was undertaken for 100 patients. Median cost was £9,429 [<euro>10,896], increasing to £14,435 [<euro>16,681], for those requiring an upgrade from residential to nursing home care. Seventy-six percent of costs were attributable to hospital bed days, and therefore, interventions targeted at reducing hospital stay may be cost effective.
  
  
  BACKGROUND
  Previous studies have estimated the costs associated with hip fracture, although these vary widely, and for patients admitted from care homes, who represent a significant fracture burden, there are limited data. The primary aim of this study was to perform a detailed assessment of the direct medical costs incurred and secondly compare this to the actual remuneration received by the hospital.
  
  
  METHODS
  One hundred patients presenting from a care home in 2006 were randomly selected and a detailed case-note costing analysis was undertaken. This cost was then compared to the actual remuneration received by the hospital.
  
  
  RESULTS
  Median cost per patient episode was £9,429 [<euro>10,896] (all patients) range £4,292-162,324 [<euro>4,960-187,582] (subdivided into hospital bed day costs £7,129 [<euro>8,238], operative costs £1,323 [<euro>1,529] and investigation costs £977 [<euro>1,129]). Twenty-two percent of the patients admitted from a residential home required upgrading to a nursing home. In this group, the median length of stay was 31 days (mean 38, range 10-88) median cost £14,435 [<euro>16,681]. Average remuneration received equated to £6,222 [<euro>7,190] per patient. This represents a mean loss in income, compared to actual calculated costs of £3,207 [<euro>3,706] per patient.
  
  
  CONCLUSIONS
  The median cost was £9,429 [<euro>10,896], increasing to £14,435 [<euro>16,681], for those requiring an upgrade from residential to nursing home care at discharge. Significant cost differences were seen comparing the actual cost to remuneration received. Interventions targeted at reducing length of stay may be cost effective.
authors.affiliation: Department of Elderly Medicine, Nottingham University Hospitals, Nottingham, UK. opinder.sahota@nuh.nhs.uk
authors.forename: O
authors.initials: O
authors.lastname: Sahota
authors.forename: N
authors.initials: N
authors.lastname: Morgan
authors.forename: C G
authors.initials: CG
authors.lastname: Moran
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000191:economics; D003955:Diagnostic Tests, Routine / Q000191:economics; D005260:Female; D005593:Fracture Fixation, Internal / Q000191:economics; D006302:Health Services Research / Q000379:methods; D006620:Hip Fractures / Q000175:diagnosis / Q000191:economics* / Q000601:surgery; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000191:economics* / Q000601:surgery; D010351:Patient Discharge; D060926:Remuneration; D006113:United Kingdom