Post-Acute Care Setting After Hip Fracture Hospitalization and Subsequent Opioid Use in Older Adults

Cupp, Meghan A.; Beaudoin, Francesca L.; Hayes, Kaleen N; Riester, Melissa R.; Berry, Sarah D.; Joshi, Richa; Zullo, Andrew R.

doi:10.1016/j.jamda.2023.03.012

Journal of the American Medical Directors Association

2023

DOI: 10.1016/j.jamda.2023.03.012

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Post-Acute Care Setting After Hip Fracture Hospitalization and Subsequent Opioid Use in Older Adults

Meghan A. Cupp

Francesca L. Beaudoin

Kaleen N Hayes

et al.

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2024

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Cited by 2 publications

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“…The percentage of Ohio public retirees and other Ohio Humana MA enrollees receiving only HH or SNF was greater than 75% in 2015, but fell for Ohio public retirees in 2016 (Figure, C); the overall high rate of SNF admissions reflects that approximately half of the sample was comprised of patients with hip fracture , a condition that has a high rate of discharge to SNFs after hospitalization 21. …”

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Postacute Care for Medicare Advantage Enrollees Who Switched to Traditional Medicare Compared With Those Who Remained in Medicare Advantage

Huckfeldt,

Shier,

Escarce

et al. 2024

JAMA Health Forum

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ImportanceMedicare Advantage (MA) plans receive capitated per enrollee payments that create financial incentives to provide care more efficiently than traditional Medicare (TM); however, incentives could be associated with MA plans reducing use of beneficial services. Postacute care can improve functional status, but it is costly, and thus may be provided differently to Medicare beneficiaries by MA plans compared with TM.ObjectiveTo estimate the association of MA compared with TM enrollment with postacute care use and postdischarge outcomes.Design, Setting, and ParticipantsThis was a cohort study using Medicare data on 4613 hospitalizations among retired Ohio state employees and 2 comparison groups in 2015 and 2016. The study investigated the association of a policy change with use of postacute care and outcomes. The policy changed state retiree health benefits in Ohio from a mandatory MA plan to subsidies for either supplemental TM coverage or an MA plan. After policy implementation, approximately 75% of retired Ohio state employees switched to TM. Hospitalizations for 3 high-volume conditions that usually require postacute rehabilitation were assessed. Data from the Medicare Provider Analysis and Review files were used to identify all hospitalizations in short-term acute care hospitals. Difference-in-difference regressions were used to estimate changes for retired Ohio state employees compared with other 2015 MA enrollees in Ohio and with Kentucky public retirees who were continuously offered a mandatory MA plan. Data analyses were performed from September 1, 2019, to November 30, 2023.ExposuresEnrollment in Ohio state retiree health benefits in 2015, after which most members shifted to TM.Main Outcomes and MeasuresReceived care in an inpatient rehabilitation facility, skilled nursing facility, or home health, or any postacute care; the occurrence of any hospital readmission; the number of days in the community during the 30 days after hospital discharge; and mortality.ResultsThe study sample included 2373 hospitalizations for Ohio public retirees, 1651 hospitalizations for other Humana MA enrollees in Ohio, and 589 hospitalizations for public retirees in Kentucky. After the 2016 policy implementation, the percentage of hospitalizations covered by MA decreased by 70.1 (95% CI, −74.2 to −65.9) percentage points (pp), inpatient rehabilitation facility admissions increased by 9.7 (95% CI, 4.7 to 14.7) pp, use of only home health or skilled nursing facility care fell by 8.6 (95% CI, −14.6 to −2.6) pp, and days in the community fell by 1.6 (95% CI, −2.9 to −0.3) days for Ohio public retirees compared with other Humana MA enrollees in Ohio. There was no change in 30-day mortality or hospital readmissions; similar results were found by comparisons using Kentucky public retirees as a control group.Conclusions and RelevanceThe findings of this cohort study indicate that after a change in retiree health benefits, most Ohio public retirees shifted from MA to TM and received more intensive postacute care with no significant change in measured short-term postdischarge outcomes. Future work should consider additional measures of postacute functional status over a longer follow-up period.

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confidence: 99%

Postacute Care for Medicare Advantage Enrollees Who Switched to Traditional Medicare Compared With Those Who Remained in Medicare Advantage

Huckfeldt,

Shier,

Escarce

et al. 2024

JAMA Health Forum

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Outcomes after hip fracture surgery in patients receiving non-steroidal anti-inflammatory drugs alone, acetaminophen alone, or both

Hatano,

Sasabuchi,

Ishikura

et al. 2024

Bone Joint J

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AimsThe use of multimodal non-opioid analgesia in hip fractures, specifically acetaminophen combined with non-steroidal anti-inflammatory drugs (NSAIDs), has been increasing. However, the effectiveness and safety of this approach remain unclear. This study aimed to compare postoperative outcomes among patients with hip fractures who preoperatively received either acetaminophen combined with NSAIDs, NSAIDs alone, or acetaminophen alone.MethodsThis nationwide retrospective cohort study used data from the Diagnosis Procedure Combination database. We included patients aged ≥ 18 years who underwent surgery for hip fractures and received acetaminophen combined with NSAIDs (combination group), NSAIDs alone (NSAIDs group), or acetaminophen alone (acetaminophen group) preoperatively, between April 2010 and March 2022. Primary outcomes were in-hospital mortality and complications. Secondary outcomes were opioid use postoperatively; readmission within 90 days, one year, and two years; and total hospitalization costs. We used propensity score overlap weighting models, with the acetaminophen group as the reference group.ResultsWe identified 93,018 eligible patients, including 13,068 in the combination group, 29,203 in the NSAIDs group, and 50,474 in the acetaminophen group. Propensity score overlap weighting successfully balanced patient characteristics among the three groups, with no significant difference in in-hospital mortality rates observed among the groups (combination group risk difference 0.0% (95% CI -0.5 to 0.4%); NSAIDs group risk difference -0.2% (95% CI -0.5 to 0.2%)). However, the combination group exhibited a significantly lower risk of in-hospital complications than the acetaminophen group (risk difference -1.9% (95% CI -3.2 to -0.6%)) as well as a significantly lower risk of deep vein thrombosis (risk difference -1.4% (95% CI -2.2 to -0.7%)). Furthermore, total hospitalization costs were higher in the NSAIDs group than in the acetaminophen group (difference USD $438 (95% CI 249 to 630); p < 0.001). No significant differences in other secondary outcomes were observed among the three groups.ConclusionThe combination of acetaminophen with NSAIDs appears to be safe and advantageous in terms of reducing in-hospital complications.Cite this article: Bone Joint J 2024;106-B(8):849–857.

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Post-Acute Care Setting After Hip Fracture Hospitalization and Subsequent Opioid Use in Older Adults

Cited by 2 publications

References 34 publications

Postacute Care for Medicare Advantage Enrollees Who Switched to Traditional Medicare Compared With Those Who Remained in Medicare Advantage

Postacute Care for Medicare Advantage Enrollees Who Switched to Traditional Medicare Compared With Those Who Remained in Medicare Advantage

Outcomes after hip fracture surgery in patients receiving non-steroidal anti-inflammatory drugs alone, acetaminophen alone, or both

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