Comparing the Contributions of Acute and Postacute Care Facility Characteristics to Outcomes After Hospitalization for Hip Fracture.
OBJECTIVE
To quantify the contribution of acute versus postacute care factors to survival and functional outcomes after hip fracture.


METHODS
Retrospective cohort study using Medicare data; subjects included previously ambulatory nursing home residents hospitalized for hip fracture between 2005 and 2009.


METHODS
We used logistic regression to measure the associations of hospital and nursing home factors with functional and survival outcomes at 30 and 180 days among patients discharged to a nursing facility; we quantified the contribution of hospital versus nursing home factors to outcomes by the ω statistic.


RESULTS
Among 45,996 hospitalized patients, 1814 (3.9%) died during hospitalization. A total of 42,781 (93%) were discharged alive to a nursing home. Of these, 12,126 (28%) died within 180 days and 20,479 (48%) died or were newly unable to walk within 180 days. Hospital characteristics were not consistently associated with outcomes. Multiple nursing home characteristics predicted 30- and 180-day outcomes, including bed count, chain membership, and performance on selected quality measures. Nursing home factors explained 3 times more variation in the odds of 30-day mortality than did hospital factors [ω, hospital vs. nursing home: 0.32; 95% confidence interval (CI), 0.11, 0.96], 7 times more variation in the odds of 180-day mortality (ω: 0.15; 95% CI, 0.04, 0.61), and 8 times more variation in the odds of 180-day death or new dependence in locomotion (ω: 0.12; 95% CI, 0.05, 0.31).


CONCLUSIONS
Nursing home factors explain a larger proportion of the variation in clinical outcomes following hip fracture than do hospital factors.
*Department of Anesthesiology and Critical Care, Perelman School of Medicine †Leonard Davis Institute for Health Economics ‡Department of Medicine, Division of Geriatric Medicine, Perelman School of Medicine, The University of Pennsylvania §Center for Outcomes Research, The Children's Hospital of Philadelphia ∥Department of Pediatrics, Perelman School of Medicine ¶Health Care Management Department, The Wharton School #Department of Medicine, Division of General Internal Medicine, Perelman School of Medicine, The University of Pennsylvania **Crescenz VA Medical Center, Philadelphia, PA.
Mark D
MD
Neuman
Jeffrey H
JH
Silber
Molly R
MR
Passarella
Rachel M
RM
Werner
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D006278:Medicare; D009735:Nursing Homes; D020127:Recovery of Function; D012307:Risk Factors; D019467:Subacute Care; D016019:Survival Analysis; D014481:United States