Does Health Reform Change Femoral Neck Fracture Care? A Natural Experiment in the State of Massachusetts.
OBJECTIVE
To determine whether hospital processes and hospital quality associated with the care of femoral neck fractures were significantly altered by the implementation of healthcare reform in Massachusetts.


METHODS
Pre-post retrospective study.


METHODS
Massachusetts Statewide Inpatient Dataset (SID).


METHODS
Patients treated for femoral neck fracture (n = 23,485) in the periods prehealth (2003-06) and posthealth reform (2008-10).


METHODS
Differences in hospital processes for fracture care and quality measures were assessed for the periods before and after health reform.


METHODS
Differences in hospital processes for fracture care (type of surgical intervention, length of stay, and discharge disposition) and quality metrics [mortality, complications, re-operation, and failure to rescue (FTR)] in the periods before and after health reform were assessed using regression techniques to adjust for differences in case mix and the type of surgical intervention.


RESULTS
There were no significant differences in the type of surgical intervention performed prereform and postreform (P = 0.27). After adjustment for case mix and surgical intervention, length of stay was significantly reduced {regression coefficient -0.07 [95% confidence interval (CI), -0.09 to -0.06]} as were the odds of FTR [odds ratio 0.73 (95% CI, 0.59-0.92)]. Discharges to skilled nursing facilities significantly increased in the postreform period [relative risk ratio 1.15 (95% CI, 1.03-1.30)]. Findings associated with FTR were driven by changes in the detection of surveillance sensitive complications.


CONCLUSIONS
Health reform in Massachusetts led to no clinically meaningful differences in hospital processes for femoral neck fracture care. Although some differences in quality measures were noted, these cannot necessarily be attributed to health care reform.
*Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and †Robert Wood Johnson Clinical Scholars Program, Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Andrew J
AJ
Schoenfeld
Michael J
MJ
Weaver
Robyn K
RK
Power
Mitchel B
MB
Harris
D000368:Aged; D000369:Aged, 80 and over; D000067248:Failure to Rescue, Health Care; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery*; D018166:Health Care Reform / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012086:Reoperation; D012189:Retrospective Studies