title: What happens to patients when they fracture their hip during a skilled nursing facility stay?
abstract: OBJECTIVE
  To characterize outcomes of patients experiencing a fall and subsequent hip fracture while in a nursing home receiving skilled nursing facility (SNF) services.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Short-stay fee-for-service Medicare beneficiaries who experienced their first hip fracture during an SNF stay.
  
  
  METHODS
  Outcomes measured in the 90 days after the hip fracture hospitalization included community discharge (with a stay in the community <30 days), successful community discharge (in the community ≥30 days), death, and institutionalization.
  
  
  RESULTS
  Between 1999 and 2007, 27,305 hip fractures occurred among short-stay nursing home patients receiving SNF care. After surgical repair of the hip fracture, 83.9% of these patients were discharged from the hospital back to an SNF, with most (99%) returning to the facility where the hip fracture occurred. In the first 90 days after hospitalization, 24.1% of patients died, 7.3% were discharged to the community but remained fewer than 30 days, 14.0% achieved successful community discharge, and 54.6% were still in a health care institution with almost 46.4% having transitioned to long-term care.
  
  
  CONCLUSIONS
  SNF care aims to maximize the short-stay patient's independence and facilitate a safe community transition. However, experiencing a fall and hip fracture during the SNF stay was a sentinel event that limited the achievement of this goal. There is an urgent need to ensure the integration of fall prevention into the patient's plan of care. Further, falls among SNF patients may serve as indicator of quality, which consumers and payers can use to make informed health care decisions.
authors.affiliation: T.H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry and Davis School of Gerontology, University of Southern California, Los Angeles, CA; Center for Gerontology and Health Care Research, Warren Alpert School of Medicine, Brown University, Providence, RI. Electronic address: nleland@osot.usc.edu.
authors.forename: Natalie E
authors.initials: NE
authors.lastname: Leland
authors.affiliation: Center for Gerontology and Health Care Research, Warren Alpert School of Medicine, Brown University, Providence, RI.
authors.forename: Pedro
authors.initials: P
authors.lastname: Gozalo
authors.affiliation: Dartmouth Institute for Health Policy and Clinical Practice, The Geisel School of Medicine at Dartmouth, Hanover, NH.
authors.forename: Julie
authors.initials: J
authors.lastname: Bynum
authors.affiliation: Center for Gerontology and Health Care Research, Warren Alpert School of Medicine, Brown University, Providence, RI; Providence Veteran's Administration Medical Center, Providence, RI.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
authors.affiliation: Abt Associates, Boston, MA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Christian
authors.affiliation: Center for Gerontology and Health Care Research, Warren Alpert School of Medicine, Brown University, Providence, RI.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Teno
mesh_terms: D000058:Accidental Falls; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000601:surgery*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012866:Skilled Nursing Facilities; D014481:United States
keywords: Skilled nursing facilities; accidental falls; community discharge; hip fracture