Administrative health data: guilty until proven innocent. Response to comments by Levy and Sobolev

Berry, Sarah D.; Zullo, Andrew R.; McConeghy, Kevin W.; Lee, Y.; Daiello, Lori A.; Kiel, D. P.

doi:10.1007/s00198-017-4244-4

Cited by 4 publications

(2 citation statements)

References 7 publications

(4 reference statements)

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“…It is possible that some facilities avoided hospitalizing residents, and this may have influenced our results. [48, 49] Use of other non-Medicare non-Medicaid insurance coverage is likely to be rare, and would not have a strong influence on the ascertainment of fracture or other key characteristics as measured by the MDS or OSCAR. Fourth, we restricted our study to facilities with ≥100 beds because facilities that had 100 or fewer residents contribute little information to the estimation of between-facility variability in hip fracture rates.…”

Section: Discussionmentioning

confidence: 99%

Facility and State Variation in Hip Fracture in U.S. Nursing Home Residents

Zullo

Zhang

Banerjee

et al. 2018

J American Geriatrics Society

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Section: Discussionmentioning

confidence: 99%

Facility and State Variation in Hip Fracture in U.S. Nursing Home Residents

Zullo

Zhang

Banerjee

et al. 2018

J American Geriatrics Society

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“…Because LE fractures may be treated in either an inpatient or an outpatient setting, 13,14 the source population included all long-stay NH residents enrolled in both Medicare parts A (inpatient) and B (outpatient) between January 1, 2008, and December 31, 2009, with follow-up through December 31, 2011. We defined long-stay as older adults who had spent 100 days or more in the same NH with no more than 10 consecutive days outside the facility.…”

Section: Study Populationmentioning

confidence: 99%

Incidence of Lower‐Extremity Fractures in US Nursing Homes

Sine

Lee

Zullo

et al. 2019

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Limited studies suggest lower‐extremity (LE) fractures are morbid events for nursing home (NH) residents. Our objective was to conduct a nationwide study comparing the incidence and resident characteristics associated with hip (proximal femur) vs nonhip LE (femoral shaft and tibia‐fibula) fractures in the NH. DESIGN Retrospective cohort study. SETTING US NHs. PARTICIPANTS We included all long‐stay residents, aged 65 years or older, enrolled in Medicare from January 1, 2008, to December 31, 2009 (N = 1 257 279). Residents were followed from long‐stay qualification until the first event of LE fracture, death, or end of follow‐up (2 years). MEASUREMENTS Fractures were classified using Medicare diagnostic and procedural codes. Function, cognition, and medical status were obtained from the Minimum Data Set prior to long‐stay qualification. Incidence rates (IRs) were calculated as the total number of fractures divided by person‐years. RESULTS During 42 800 person‐years of follow‐up, 52 177 residents had an LE fracture (43 695 hip, 6001 femoral shaft, 2481 tibia‐fibula). The unadjusted IRs of LE fractures were 1.32/1000 person‐years (95% confidence interval [CI] = 1.27‐1.38) for tibia‐fibula, 3.20/1000 person‐years (95% CI = 3.12‐3.29) for femoral shaft, and 23.32/1000 person‐years (95% CI = 23.11‐23.54) for hip. As compared with hip fracture residents, non‐hip LE fracture residents were more likely to be immobile (58.1% vs 18.4%), to be dependent in all activities of daily living (31.6% vs 10.8%), to be transferred mechanically (20.5% vs 4.4%), to be overweight (mean body mass index = 26.6 vs 24.0 kg/m2), and to have diabetes (34.8% vs 25.7%). CONCLUSIONS Our findings that non‐hip LE fractures often occur in severely functionally impaired residents suggest these fractures may have a different mechanism of injury than hip fractures. The resident differences in our study highlight the need for distinct prevention strategies for hip and non‐hip LE fractures.

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