Hip Fracture Hospitalizations: Quality of Post-Acute Care Determines Long-Term Outcomes

A new study published in Medical Care suggests that the quality of the post-acute care older adults receive after being hospitalized with a hip fracture has a greater impact on long-term recovery than the care they received at the hospital (2016; doi:10.1097/MLR.0000000000000664). 

In a statement, lead author Mark D Neuman, MD, MSc, assistant professor at the Perelman School of Medicine at the University of Pennsylvania (Philadelphia, PA), said, “These results highlight the major impact that post-acute care has on basic outcomes such as survival and walking ability among this patient population.”

The retrospective cohort study used Medicare data of individuals who were ambulatory nursing home residents hospitalized for hip fracture between 2005 and 2009. Dr Neuman and his colleagues 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.

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.

In summary, researchers found that the impact of post-acute care outcomes, including mortality and mobility, was three to eight times greater than the impact of hospital factors. Overall, nursing home factors explained three times more variation in a patient’s probability of dying at 30 days than hospital factors, seven times more variation in the probability of dying at 180 days, and eight times more variation in the probability of dying or being newly unable to walk at 180 days.

Nursing home market concentration and ownership by a multifacility organization were also modestly associated with 30-day mortality. More, facilities that used more physician assistants and nurse practitioners and those with a full-time directors of nursing were modestly associated with 180-day mortality. Nursing homes located within a hospital were also associated with 180-day mortality.

“For patients, it sends the simple message that post-acute care, for instance, at a nursing home, may have a major impact on recovery in the long term,” Dr Neuman said.

The next phase of this research should explore the impact on these factors on outcomes for older adults hospitalized for conditions other than hip fractures, as well as the processes within facilities that may help explain the variations in the outcomes observed in this study, the authors wrote.—Amanda Del Signore