title: Municipal resources and patient outcomes through the first year after a hip fracture.
abstract: Hip fractures represent major critical events for older people, and put huge demands on economic and personnel resources. Most hip fracture patients are in need of postoperative rehabilitation services. Through the Coordination Reform, the municipalities in Norway were given increased responsibility for community-based treatment and rehabilitation after surgery. The purpose of this study was to examine associations between municipal resources and patient outcomes through the first year after a hip fracture, focusing on survival and health-related quality of life.
  
  
  
  We conducted a nationwide cohort study on people experiencing a hip fracture in 2011-2012 in Norway, with a 1-year follow-up. We obtained data on date of hip fracture, demographics, total morbidity (ASA) score, health-related quality of life (EQ-5D-3 L), date of death if applicable, municipality of residence (Norwegian Hip Fracture Register), date of hospital readmission due to complications (Norwegian Patient Register), and information on municipalities' characteristics (Municipality-State-Reporting).
  
  
  
  The study population comprised 15,757 patients, mean age 80.8 years, 68.6% women. All-cause mortality was 8.6% at 30 days, and 25.3% at 12 months. Mortality was lower in the municipalities with the highest overall staff time for rehabilitation. A high proportion of the population aged 80+, was associated with low rates of self-reported anxiety/depression 12 months after surgery, as well as higher general health scores (EQ-5D VAS). There were no other differences in outcome according to rehabilitation resources, when comparing municipalities with the highest and lowest staffing.
  
  
  
  The study revealed no substantial impact of municipal resources on survival and health-related quality of life through the first year after a hip fracture. To evaluate major organizational changes and allocate resources according to best practice, there is a need to monitor health outcomes and use of resources over time through reliable measures, including variables related to coordination between services.
authors.affiliation: Research Unit for General Practice, Uni Research Health, Bergen, Norway. sabine.ruths@uib.no.|Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway. sabine.ruths@uib.no.
authors.forename: Sabine
authors.initials: S
authors.lastname: Ruths
authors.affiliation: Uni Research Health, Bergen, Norway.
authors.forename: Valborg
authors.initials: V
authors.lastname: Baste
authors.affiliation: Research Unit for General Practice, Uni Research Health, Bergen, Norway.
authors.forename: Marit Stordal
authors.initials: MS
authors.lastname: Bakken
authors.affiliation: Department of Clinical Medicine, University of Bergen, Bergen, Norway.|Norwegian Arthroplasty Register, Haukeland University Hospital, Bergen, Norway.
authors.forename: Lars Birger
authors.initials: LB
authors.lastname: Engesæter
authors.affiliation: Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
authors.forename: Stein Atle
authors.initials: SA
authors.lastname: Lie
authors.affiliation: Uni Research Health, Bergen, Norway.
authors.forename: Siren
authors.initials: S
authors.lastname: Haugland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data* / Q000600:supply & distribution; D006620:Hip Fractures / Q000401:mortality / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D017060:Patient Satisfaction; D011788:Quality of Life; D016896:Treatment Outcome
keywords: Health services; Hip fracture; Municipal resources; Quality of life; Survival