Changing Patterns of Hip Fracture Care Before and After Implementation of the Prospective Payment System

Fitzgerald, John F.; Fagan, Lisa H.; Tierney, William M.; Dittus, Robert S.

doi:10.1097/00132586-198802000-00041

Cited by 59 publications

(71 citation statements)

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“…Poorly controlled systemic illness has been associated with an increased mortality after fracture of the hip. 2,28,36,37 In this study, patients 95 years of age and over with an active medical comorbidity at the time of admission were twice as likely to die in the first postoperative year as those presenting with no active comorbidity. Kenzora et al 9 found that four or more medical comorbidities significantly increased the post-operative mortality rate after fracture of the hip.…”

Section: Discussionmentioning

confidence: 64%

Outcome after surgery for fracture of the hip in patients aged over 95 years

Holt¹,

Macdonald²,

Fraser

et al. 2006

The Journal of Bone and Joint Surgery. British volume

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Despite the increase in numbers of the extreme elderly, little data is available regarding their outcome after surgery for fracture of the hip. We performed a prospective study of 50 patients aged 95 years and over who underwent this procedure. Outcome measures included morbidity, mortality, hospital stay, residential and walking status. Comparison was made with a control group of 200 consecutive patients aged less than 95 years who had a similar operation. The mortality at 28 and 120 days was higher (p = 0.005, p = 0.001) in the patients over 95 years. However, the one-year cumulative post-operative mortality was neither significantly different between the two groups (p = 0.229) nor from the standardised mortality rate for the age-matched population (p = 0.445). Predictors of mortality included the ASA grade, the number of comorbid medical conditions and active medical problems on admission. Patients over 95 were unlikely to recover their independence and at a mean follow-up of 29.3 months (12.1 to 48) 96% required permanent institutional care.More than 60% of patients with a fracture of the hip have significant coexisting medical problems at the time of presentation, 1 and a one-year mortality rate of between 14% and 47% has been reported. [2][3][4][5][6][7][8][9][10][11][12] The lifetime incidence of hip fracture in the United Kingdom is approximately 18% in women and 6% in men. 13 The annual incidence increases with age, rising from three per 100 women aged between 65 and 74 to 12.6 per 100 aged 85 or older. 14,15 At present there are some 250 000 people over the age of 95 residing in the United Kingdom and it is predicted that this number will increase dramatically over the next decade. 16Previous studies have associated advanced age with increased mortality after hip fracture, [17][18][19][20][21][22] and increasing age has been linked with poorer functional recovery, diminished walking ability and increased post-operative complications. 6,8,17,18,21,22 Extremely old patients represent a small but challenging subpopulation of those with fractures of the hip, but there is little published in the way of specific outcome. Patients and MethodsPatients aged 95 years and older presenting with a fracture of the hip were identified prospectively on presentation from the start of 2000 and were followed up until September 2004 either until their death or to the conclusion of the study. Follow-up information was collected from medical, general practitioner (GP) and physiotherapy/occupational therapy records and, where possible, the patients were also contacted. If a patient was unable to give the appropriate information, a family member, carer or GP was then interviewed. The data were compared that from a control cohort consisting of 200 consecutive individuals under the age of 95 who underwent similar surgery during the period of study. The control group was followed up for a period of 12 months.All fracture types were included. In the control group four patients (2%) sustained fractures which were subsequently h...

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Section: Discussionmentioning

confidence: 64%

Outcome after surgery for fracture of the hip in patients aged over 95 years

Holt¹,

Macdonald²,

Fraser

et al. 2006

The Journal of Bone and Joint Surgery. British volume

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“…Implemented in 1983, PPS provides fixed payments to hospitals per discharge based on illness categories known as diagnosis related groups. Multiple previous investigators have demonstrated increased rates of discharge to skilled nursing facilities (SNFs) following the implementation of PPS [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Patient Expectation Is the Most Important Predictor of Discharge Destination After Primary Total Joint Arthroplasty

Halawi

Vovos

Green

et al. 2015

The Journal of Arthroplasty

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“…This decrease was less than one might have expected given the considerable decrease in the LOS; this contrasts with the results ofother investigators who found decreases in the LOS and mean number of PT sessions to be more closely related. 2,5,9 Physicians, who must initiate the referral for PT, may have become more aware ofthe benefits of early mobilization and ambulation during acute illness; referral for PT services may help maintain mobility and thereby enable patients to be discharged sooner.…”

Section: Discussionmentioning

confidence: 99%

Prospective payment and the utilization of physical therapy service in the hospitalized elderly.

Holt¹,

Winograd²

1990

Am J Public Health

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We studied the effect, in a university teaching hospital, of the prospective payment system (PPS) on utilization of physical therapy (PT), a non-reimbursable service; subjects were hospitalized patients aged 75 or older with non-PT-related diagnoses (myocardial infarction, pneumonia, congestive heart failure, and colectomy) and PT-related diagnoses (cerebrovascular accident and hip fracture). The proportion of patients referred for PT increased from 68 percent pre-PPS to 85 percent post-PPS for those with PT-related diagnoses and from 13 percent pre-PPS to 19 percent post-PPS for those with

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Changing Patterns of Hip Fracture Care Before and After Implementation of the Prospective Payment System

Cited by 59 publications

References 0 publications

Outcome after surgery for fracture of the hip in patients aged over 95 years

Outcome after surgery for fracture of the hip in patients aged over 95 years

Patient Expectation Is the Most Important Predictor of Discharge Destination After Primary Total Joint Arthroplasty

Prospective payment and the utilization of physical therapy service in the hospitalized elderly.

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