title: Policy encouraging earlier hip fracture surgery can decrease the long-term mortality of elderly patients.
abstract: BACKGROUND
  In April 2004 the Israeli Ministry of Health decided to condition DRG payment for hip surgery by time between hospitalisation and operation, giving a fine for every day's delay beyond 48h. An evaluation study performed 2 years after the reform has shown the positive influence of the reform on patient's survival in the hospital. This study evaluates the impact of the reform on the longer-term mortality of patients.
  
  
  METHODS
  A retrospective study based on data from nine hospitals of the national trauma registry available for the years 2001-2007, with surveillance on 2-year survival through data of Ministry of the Interior. The study population includes patients aged 65 and above with an isolated hip fracture following trauma. Mortality curves and Cox regression were utilised to compare the influence of different parameters on long-term mortality.
  
  
  RESULTS
  Earlier surgery had a significant positive impact on survival through the whole length of the study period. In the period after the introduction of the new reimbursement system for hip fracture surgeries, a significant decrease in the longer-term mortality was observed up to 6 months of follow-up, even when adjusted by patients' age, gender and the receiving hospital. After 6 months there was no further decrease in relative risk, though the survival advantage remained with patients hospitalised after the reform.
  
  
  CONCLUSIONS
  The reform appears successful in decreasing the longer-term patient mortality after hip fracture through influencing surgical practice.
authors.affiliation: National Center for Trauma & Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Ramat Gan, Israel; School of Public Health, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: KobiP@gertner.health.gov.il.
authors.forename: Kobi
authors.initials: K
authors.lastname: Peleg
authors.affiliation: National Center for Trauma & Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Ramat Gan, Israel; School of Public Health, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Rozenfeld
authors.affiliation: National Center for Trauma & Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Ramat Gan, Israel.
authors.forename: Irina
authors.initials: I
authors.lastname: Radomislensky
authors.affiliation: Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Ramat Gan, Israel.
authors.forename: Ilya
authors.initials: I
authors.lastname: Novikov
authors.affiliation: Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Tel-Hashomer, Ramat Gan, Israel.
authors.forename: Laurence S
authors.initials: LS
authors.lastname: Freedman
authors.affiliation: Hadassah - Hebrew University Medical Center, Jerusalem, Israel; Ministry of Health, Jerusalem, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Israeli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006291:Health Policy; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D011050:Policy Making; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: DRG; Earlier surgery; Hip fracture; Long-term mortality