title: State of origin: Australian states use widely different resources for hospital management of hip fracture, but achieve similar outcomes.
abstract: Objective Hospital management of hip fracture varies widely with regard to length of stay, delivery of post-surgical care and costs. The present study compares the association between hospital utilisation and costs and patient outcomes in the six Australian states. Methods The present study was a retrospective cohort study of linked administrative databases for 2530 Australian veterans and war widows aged ≥65 years, hospitalised for hip fracture in 2008-09. Department of Veterans' Affairs datasets for hospital episodes, residential aged care admissions and date of death were linked. Patient characteristics, hospital utilisation and process data, rates of mortality and residential care placement and delivery of community services were compared for patients from each of the states. Results There were no significant differences in fracture incidence, patient demographics or fracture type among the states. Adjusted total mean length of hospital stay ranged from 24.7 days (95% confidence interval (CI) 22.3-27.5 days) to 35.0 days (95% CI 32.6-37.6 days; P<0.001) and adjusted total hospital cost ranged between A$24792 (95% CI A$22191-A$27700) and A$35494 (95% CI A$32853-A$38343; P<0.001). Rates of referral to rehabilitation ranged from 31.7% to 50.4% (P=0.003). At 1 year, there were no significant differences between states for key outcome determinants of mortality (P=0.71) or for the proportion of patients who retained their independent living status (P=0.66). Conclusion Hospital resources for management of hip fracture differ substantially among the Australian states. Key medium-term patient outcomes do not show significant differences. A potential for substantial cost-efficiencies without increased risk to patient welfare is suggested. What is known about this topic? Hospital resources deployed in the initial management of hip fracture differ widely between countries, regions and individual hospitals. Patient outcomes also vary widely, but are inconsistently associated with resource outlays. What does this paper add? The paper describes the different resource outlays for management of hip fracture in six Australian jurisdictions and the absence of equivalent differences in medium-term patient outcomes. What are the implications for practitioners? Efficiencies in hospital management of hip fracture may be achievable without negative consequences for patients. The elements of models of care should be examined for their contribution to early and later patient outcomes.
authors.affiliation: Department of Veterans' Affairs, 300 Elizabeth Street, Sydney, NSW 2000, Australia.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Ireland
authors.affiliation: Sydney School of Public Health, Edward Ford Building (27), The University of Sydney, NSW 2006, Australia. Email:.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Kelly
authors.affiliation: Sydney School of Public Health, Edward Ford Building (27), The University of Sydney, NSW 2006, Australia. Email:.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cumming
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D016208:Databases, Factual; D005260:Female; D006620:Hip Fractures / Q000534:rehabilitation* / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D040841:Resource Allocation / Q000191:economics*; D012189:Retrospective Studies