Comparing the contributions of acute and post acute care facility characteristics to outcomes after hospitalization for hip fracture

In Medical Care, LDI Senior Fellows Mark Neuman, Jeffrey Silber and Rachel Werner and colleagues quantify the contribution of acute versus post acute care factors to survival and functional outcomes after hip fracture. This retrospective cohort study was conducted using Medicare data from previously ambulatory nursing home residents hospitalized for hip fracture between 2005 and 2009. The authors measured 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, and quantified the contribution of hospital versus nursing home factors to outcomes. They found that among 45,996 hospitalized patients, 3.9% (1,814) died during hospitalization while the other 93% (42,781) were discharged to a nursing home. Of these, 48% (20,479) died or were newly unable to walk within 180 days and 28% (12,126) died within 180 days. While hospital characteristics were not consistently associated with outcomes, multiple nursing home characteristics predicted 30- and 180-day outcomes, such as bed count, chain membership and performance on selected quality measures. In fact, nursing home factors explained three times more variation in the odds of 30-day mortality than did hospital factors, as well as seven times more variation in the odds of 180-day mortality, and eight times more variation in the odds of 180-day death or new dependence in locomotion. Compared with hospital factors, nursing home characteristics explain a larger proportion of the variation in outcomes after hip fracture.