title: European Regional Differences in All-Cause Mortality and Length of Stay for Patients with Hip Fracture.
abstract: The objective of this study was to compare healthcare performance for the surgical treatment of hip fractures across and within Finland, Hungary, Italy, the Netherlands, Norway, Scotland, and Sweden. Differences in age-adjusted and sex-adjusted 30-day and one-year all-cause mortality rates following hip fracture, as well as the length of stay of the first hospital episode in acute care and during a follow up of 365 days, were investigated, and associations between selected country-level and regional-level factors with mortality and length of stay were assessed. Hungary showed the highest one-year mortality rate (mean 39.7%) and the lowest length of stay in one year (12.7 days), whereas Italy had the lowest one-year mortality rate (mean 19.1 %) and the highest length of stay (23.3 days). The observed variations were largely explained by country-specific effects rather than by regional-level factors. The results show that there should still be room for efficiency gains in the acute treatment of hip fracture, and clinicians, healthcare managers, and politicians should learn from best practices. This study demonstrates that an international comparison of acute hospital care is possible using pooled individual-level administrative data.
authors.affiliation: Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Emma
authors.initials: E
authors.lastname: Medin
authors.affiliation: Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Fanny
authors.initials: F
authors.lastname: Goude
authors.affiliation: Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
authors.forename: Hans Olav
authors.initials: HO
authors.lastname: Melberg
authors.affiliation: Department of Policy Analysis and Public Management, Bocconi University, Milano, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tediosi
authors.affiliation: Semmelweis University, Budapest, Hungary.
authors.forename: Eva
authors.initials: E
authors.lastname: Belicza
authors.affiliation: Centre for Health and Social Economics (CHESS), National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Mikko
authors.initials: M
authors.lastname: Peltola
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005060:Europe / Q000453:epidemiology; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery; D006761:Hospitals; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008875:Middle Aged; D012044:Regression Analysis; D012959:Socioeconomic Factors
keywords: europe; hip fracture; length of stay; mortality; regional differences