title: The relationship between historical risk-adjusted 30-day mortality and subsequent hip fracture outcomes: Retrospective cohort study.
abstract: BACKGROUND
  While 30-day risk-adjusted mortality is a performance measure for hip fracture care, it has not been shown to predict long-term outcomes. We assessed whether hospital rankings based on historical 30-day mortality predicted subsequent hip fracture outcomes.
  
  
  METHODS
  Using national Medicare data, we calculated annual hospital performance rankings based on standardized 30-day hip fracture mortality ratios. We used logistic regression to measure the association of patients' survival at 180 days with their hospital's ranking for the year prior to admission. Subgroup analyses assessed whether associations between hospital performance and 180-day outcomes were similar for community-dwelling patients as well as those living in nursing homes prior to fracture.
  
  
  RESULTS
  Out of 378,077 patients hospitalized with hip fractures between January 1, 2007 and June 30, 2009, 81,653 (21.6%) died by 180 days. Worse historical hospital performance was associated with a greater adjusted odds of 30 day mortality (odds ratio (OR), fourth vs. first quartile: 1.24, 95% confidence interval (CI): 1.18, 1.29, P<0.001) and 180 day mortality (OR, fourth vs. first quartile: 1.15, 95% CI 1.11, 1.18, P<0.001). Past hospital performance was associated with death or new nursing home placement among community dwellers (OR, fourth vs. first quartile: 1.09, 95% CI 1.05, 1.13, P<0.001), but was not associated with death or new dependence in locomotion among nursing home residents (OR 1.05, 95% CI 0.97, 1.15, P=0.229).
  
  
  CONCLUSIONS
  Better historical hospital hip fracture mortality predicts modest decreases in mortality at 180 days for subsequent patients, but is inconsistently associated with changes in functional outcomes.
  
  
  METHODS
  Level 3 (Non-randomized controlled cohort study).
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, 1119A Blockley Hall, Philadelphia, PA 19104, Unted States; Leonard Davis Institute for Health Economics, the University of Pennsylvania, United States; Department of Internal Medicine, Division of Geriatric Medicine, Perelman School of Medicine at the University of Pennsylvania, United States. Electronic address: neumanm@mail.med.upenn.edu.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Neuman
authors.affiliation: Center for Outcomes Research, Children's Hospital of Philadelphia, United States.
authors.forename: Molly R
authors.initials: MR
authors.lastname: Passarella
authors.affiliation: Leonard Davis Institute for Health Economics, the University of Pennsylvania, United States; Department of Internal Medicine, Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, United States; Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, United States.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Werner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006620:Hip Fractures / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D015233:Models, Statistical; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014481:United States
keywords: Aging/geriatrics; Hip fracture; Quality measurement; Surgical outcomes