Days alive and at home after hip fracture: a cross-sectional validation of a patient-centred outcome measure using routinely collected data

Abstract

BackgroundDays alive and at home (DAH) is a patient centered outcome measureable in routinely collected health data. The validity and minimally important difference (MID) in hip fracture have not been evaluated.ObjectiveWe assessed construct and predictive validity and estimated a MID for the patient-centred outcome of DAH after hip fracture admission.MethodsThis is a cross-sectional observational study using linked health administrative data in Ontario, Canada. DAH was calculated as the number of days alive within 90 days of admission minus the number of days hospitalised or institutionalised. All hospital admissions (2012–2018) for hip fracture in adults aged >50 years were included. Construct validity analyses used Bayesian quantile regression to estimate the associations of postulated patient, admission and process-related variables with DAH. The predictive validity assessed was the correlation of DAH in 90 days with the value from 91 to 365 days; and the association and discrimination of DAH in 90 days predicting subsequent mortality. MID was estimated by averaging distribution-based and clinical anchor-based estimates.ResultsWe identified 63 778 patients with hip fracture. The median number of DAH was 43 (range 0–87). In the 90 days after admission, 8050 (12.6%) people died; a further 6366 (10.0%) died from days 91 to 365. Associations between patient-level and admission-level factors with the median DAH (lower with greater age, frailty and comorbidity, lower if admitted to intensive care or having had a complication) supported construct validity. DAH in 90 days after admission was strongly correlated with DAH in 365 days after admission (r=0.922). An 11-day MID was estimated.ConclusionDAH has face, construct and predictive validity as a patient-centred outcome in patients with hip fracture, with an estimated MID of 11 days. Future research is required to include direct patient perspectives in confirming MID.

Delirium in hip fracture patients admitted from home during the COVID-19 pandemic is associated with higher mortality, longer total length of stay, need for post-acute inpatient rehabilitation, and readmission to acute services

“…Few studies have assessed prevalence and outcomes of delirium in patients admitted directly from home, who likely have lower levels of frailty, dementia, and comorbidities associated both with delirium and adverse outcomes, and in whom days at home following admission with a hip fracture has been demonstrated to be a valid and important patient-centred outcome. 21,31 The reported prevalence of delirium (14.1%) in this study is slightly lower than reported by Krogseth et al 8 (19%). This may reflect the much smaller, selected sample with high levels of missing data in the latter study (85/207 did not have a preoperative delirium assessment), and different assessment methods (4AT embedded in routine practice, versus Confusion Assessment Method-based specialist assessment).…”

“…Returning to live at home on discharge is important, with days alive and at home following a hip fracture validated as a patient-centred outcome for patients aged > 50 years. 21 In a study of 207 patients admitted directly from private homes, Krogseth et al 8 reported an inpatient delirium incidence of 39%, and associations with higher mortality and risk of new institutionalization. Determining whether similar associations exist in large, population-representative datasets with routine delirium assessment is important for clinical practice.…”

Postsurgery paths and outcomes for hip fracture patients (POST-OP HIP PATHS): a population-based retrospective cohort study protocol

“…Our primary outcome is place of care/residence at 6 and 12 months postsurgery (eg, death, acute hospital, long-term care, rehabilitation, home with support, home no support). 19 Our secondary outcomes are return to the emergency department within 90 days of hospital discharge (and reason), hospital readmissions with 90 days of discharge (and reason), new long-term care admission, an adjusted validated day alive at home indicator, 20 survival at 6 and 12 months, health service utilisation (eg, follow-up visits with family physicians or specialists, new or increased home care services) and healthcare costs across the system using a costing macro developed at ICES. 21 For patients discharged home with home care, complex continuing care or long-term care, we will additionally capture functional status at rehabilitation discharge (eg, self-care, sphincter control, transfers, locomotion, communication, social cognition), cognition level and health-related quality of life.…”

Novel patient-centred outcome in cancer care, days at home: a scoping review protocol

“…Several terms have been applied to the construct captured by DAH in the literature including but not limited to DAH, time at home, days spent at home, days alive and out of hospital, days alive and at home, home time and healthy DAH 11–13 16 18–20. Accordingly, definitions have been inconsistent.…”