title: The Determinants of Costs and Length of Stay for Hip Fracture Patients.
abstract: OBJECTIVE
  An ageing population at greater risk of proximal femoral fracture places an additional clinical and financial burden on hospital and community medical services. We analyse the variation in i) length of stay (LoS) in hospital and ii) costs across the acute care pathway for hip fracture from emergency admission, to hospital stay and follow-up outpatient appointments.
  
  
  METHODS
  We analyse patient-level data from England for 2009/10 for around 60,000 hip fracture cases in 152 hospitals using a random effects generalized linear multi-level model where the dependent variable is given by the patient's cost or length of stay (LoS). We control for socio-economic characteristics, type of fracture and intervention, co-morbidities, discharge destination of patients, and quality indicators. We also control for provider and social care characteristics.
  
  
  RESULTS
  Older patients and those from more deprived areas have higher costs and LoS, as do those with specific co-morbidities or that develop pressure ulcers, and those transferred between hospitals or readmitted within 28 days. Costs are also higher for those having a computed tomography (CT) scan or cemented arthroscopy. Costs and LoS are lower for those admitted via a 24h emergency department, receiving surgery on the same day of admission, and discharged to their own homes.
  
  
  CONCLUSIONS
  Patient and treatment characteristics are more important as determinants of cost and LoS than provider or social care factors. A better understanding of the impact of these characteristics can support providers to develop treatment strategies and pathways to better manage this patient population.
authors.affiliation: Centre for Health Economics, University of York, Heslington, York, YO10 5DD, United Kingdom.
authors.forename: Adriana
authors.initials: A
authors.lastname: Castelli
authors.affiliation: Food and Agricultural Organization of the United Nations, Viale Aventino 1, Rome, 00153 Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Daidone
authors.affiliation: Centre for Health Economics, University of York, Heslington, York, YO10 5DD, United Kingdom.
authors.forename: Rowena
authors.initials: R
authors.lastname: Jacobs
authors.affiliation: Centre for Health Economics, University of York, Heslington, York, YO10 5DD, United Kingdom.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kasteridis
authors.affiliation: Centre for Health Economics, University of York, Heslington, York, YO10 5DD, United Kingdom.
authors.forename: Andrew David
authors.initials: AD
authors.lastname: Street
mesh_terms: D017048:Health Care Costs; D006620:Hip Fractures / Q000191:economics* / Q000628:therapy; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D018803:Models, Economic; D010351:Patient Discharge / Q000191:economics