title: Factors that affect fractured neck of femur outcome: Clinical commissioning groups influence length of stay and discharge destination.
abstract: BACKGROUND
  The average length of stay (LOS) following a hip fracture in hospitals around the UK has been approximately 20 days in recent years. This can vary between hospitals and there are numerous factors that can affect LOS. We had the impression that LOS varied by Clinical Commissioning Group (CCG) from which the patient originates. The aim of our study was to discover whether the concern was valid, and if so, what the reasons may be.
  
  
  METHODS
  We analysed hip fracture data collected at our Trust between September 2008 and December 2014. LOS was compared for each of three CCGs in our Trust's catchment areas, and those patients admitted from outlying CCGs. Sub-analysis was performed by patient age, ASA grade, abbreviated mental test score, procedure type and discharge destination to determine which factors influence LOS.
  
  
  RESULTS
  1847 patients were identified. After excluding deaths, missing data and extreme outliers, 1603 patients were included in the analysis. The median LOS varied from 14.9 to 23.4 days across CCGs. The major reason for this variation was discharge destination. CCGs associated with longer LOS had a significantly higher rate of discharge to the patient's own home, rather than institutional care. This was independent of patient age, mental status, ASA grade and promptness of surgery.
  
  
  CONCLUSIONS
  We have shown that CCGs vary in their performance to aid discharge. This directly influences a Trust's performance on the National Hip Fracture Database. Compared with other hospitals, our results show a poor outcome in terms of length of stay, but much better performance regarding home discharge. We recommend that more emphasis in future be placed on discharge destination than LOS.
authors.affiliation: Department of Orthopaedics, University Hospital South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT. Electronic address: martin.sharrock@doctors.org.uk.
authors.forename: M N
authors.initials: MN
authors.lastname: Sharrock
authors.affiliation: Department of Orthopaedics, University Hospital South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT.
authors.forename: R M
authors.initials: RM
authors.lastname: Davies
authors.affiliation: Department of Orthopaedics, University Hospital South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT.
authors.forename: P
authors.initials: P
authors.lastname: Smith
authors.affiliation: Department of Orthopaedics, University Hospital South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT.
authors.forename: M E
authors.initials: ME
authors.lastname: Lovell
mesh_terms: D015897:Comorbidity; D016208:Databases, Factual; D003695:Delivery of Health Care; D005260:Female; D005265:Femoral Neck Fractures / Q000453:epidemiology / Q000503:physiopathology / Q000534:rehabilitation; D006302:Health Services Research; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: Hip fractures; Hospital discharge; Length of stay; Rehabilitation