title: Comparing Survival Following Hip Fracture Repair in VHA and Non-VHA Facilities.
abstract: BACKGROUND
  Although postsurgical outcomes are similar between Veterans Health Administration (VHA) and non-VHA hospitals for many procedures, no studies have compared 30-day and 1-year survival following hip fracture repair. Therefore, this study compared survival of veterans aged 65 years and older treated in VHA hospitals with a propensity-matched cohort of Medicare beneficiaries in non-VHA hospitals.
  
  
  METHODS
  Retrospective cohort study of 1894 hip fracture repair patients in VHA or non-VHA hospitals between 2003 and 2005. Current Procedural Terminology codes identified 3542 male patients aged >65 years who had hip fracture repair between 2003 and 2005 in the Veterans Affairs' National Surgical Quality Improvement Program database. The Medicare comparison sample was drawn from 2003 to 2005 Medicare Part A inpatient hospital claims files. To create comparable VHA and Medicare cohorts, patients were propensity score matched on age, admission source (community vs. nursing home), repair type, comorbidity index, race, year, and region. Thirty-day and 1-year survival after surgery were compared between cohorts after further adjustment for selected comorbidities, year of surgery, and pre- and postsurgical length of hospital stay using logistic regression.
  
  
  RESULTS
  Odds of survival were significantly better in the Medicare than the VHA cohort at 30 days (1.68, 95% CI 1.15-2.44) and 1 year (1.35, 95% CI 1.08-1.69).
  
  
  CONCLUSIONS
  Medicare beneficiaries with hip fracture repair in non-VHA hospitals had better survival than veterans in VHA hospitals. Whether this is driven by unobserved patient characteristics or systematic care differences is unknown.
authors.affiliation: Denver-Seattle Center of Innovation VA Eastern Colorado Health Care System Denver, CO, USA ; Department of Medicine and School of Public Health University of Colorado Anschutz Medical Campus Aurora, CO, USA.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Hutt
authors.affiliation: Department of Health Policy & Management, School of Public Health, Texas A&M Health Science Center, College Station, TX, USA.
authors.forename: Tiffany A
authors.initials: TA
authors.lastname: Radcliff
authors.affiliation: Department of Medicine and School of Public Health University of Colorado Anschutz Medical Campus Aurora, CO, USA.
authors.forename: William
authors.initials: W
authors.lastname: Henderson
authors.affiliation: Department of Medicine, Duke University Medical Center, Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Maciejewski
authors.affiliation: Department of Health Outcomes and Policy Malcolm G. Randall VA Medical Center, Gainesville, FL, USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Cowper-Ripley
authors.affiliation: Denver-Seattle Center of Innovation VA Eastern Colorado Health Care System Denver, CO, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Whitfield
keywords: comparative effectiveness; hip fracture repair; survival; veteran