What Happens to Patients When They Fracture Their Hip During a Skilled Nursing Facility Stay?

Abstract

Objectives To characterize outcomes of patients experiencing a fall and subsequent hip fracture while in a nursing home (NH) receiving skilled nursing facility (SNF) services. Design Observational study. Participants Short-stay fee-for-service Medicare beneficiaries who experienced their first hip fracture during a SNF stay. Measurements Outcomes measured in the 90 days after the hip fracture hospitalization included community discharge (with a stay in the community < 30 days), successful community discharge (in the community ≥30 days), death, and institutionalization. Results Between 1999 and 2007, 27,305 hip fractures occurred among short-stay nursing home patients receiving SNF care. After surgical repair of the hip fracture, 83.9% of these patients were discharged from the hospital back to a SNF, with most (99%) returning to the facility where the hip fracture occurred. In the first 90 days after hospitalization, 24.1% of patients died, 7.3% were discharged to the community but remained less than 30 days, 14.0% achieved successful community discharge, and 54.6% were still in a health care institution with almost 46.4% having transitioned to long-term care. Conclusion SNF care aims to maximize the short-stay patient’s independence and facilitate a safe community transition. However, experiencing a fall and hip fracture during the SNF stay was a sentinel event that limited the achievement of this goal. There is an urgent need to ensure the integration of fall prevention into the patient’s plan of care. Further, falls among SNF patients may serve as indicator of quality, which consumers and payers can use to make informed healthcare decisions.

Scoping review of potential quality indicators for hip fracture patient care

“…This finding supports the conclusions of Duncan and Velozo 39 and Leland and colleagues. 40 Almost 10 years ago, Duncan and Velozo concluded that although validated outcome measures exist in the postacute rehabilitation period, there is a lack of quality indicators to actually assess the care delivered in the USA. 39 Similar conclusions were made more recently by Leland and colleagues, who stated that owing to the limited number of quality of care measures in the postacute period, stakeholders (ie, patients, families, payers and providers) are left without required information to make important decisions for hip fracture rehabilitation in the USA.…”

“…39 Similar conclusions were made more recently by Leland and colleagues, who stated that owing to the limited number of quality of care measures in the postacute period, stakeholders (ie, patients, families, payers and providers) are left without required information to make important decisions for hip fracture rehabilitation in the USA. 106 Two important potential indictors for quality of rehabilitative care in the postacute period that were found in the literature were functional ability and quality of life.…”

Assessment of Activity of Daily Living Among Older Adult Patients in Home Healthcare and Skilled Nursing Facilities

“…Among the eight reviewed articles, five were cross sectional studies (Lee, 2006; Leland et al 2015; Madigan et al, 2012; Scharpf & Madigan, 2010; Wysocki, Thomas & Mor, 2015), one quasi experimental study (Tinetti, Charpentier, Gottschalk & Baker., 2012), one prospective cohort study (Thygesen, Saevereid, Linstrom, Nygaard & Engedal, 2009) and one retrospective cohort study (Jung, Trivedi, Grabowski et al, 2016). Four of the studies were conducted in HHC settings (Thygesen et al, 2009; Scharpf et al, 2010; Madigan et al, 2012 & Tinetti et al, 2012) and four in SNF (Lee, 2006; Wysocki et al, 2015; Leland et al, 2015 & Jung et al, 2016).…”

“…Four of the studies were conducted in HHC settings (Thygesen et al, 2009; Scharpf et al, 2010; Madigan et al, 2012 & Tinetti et al, 2012) and four in SNF (Lee, 2006; Wysocki et al, 2015; Leland et al, 2015 & Jung et al, 2016). Of the 4 HHC studies, one was conducted in a single site (Tinetti et al 2012), one in a multi city HHC in Norway (Thygesen et al, 2009), and 2 used large representative samples from the United States (Madigan et al 2012; Scharpf, et al 2010).…”

“…Of the 4 HHC studies, one was conducted in a single site (Tinetti et al 2012), one in a multi city HHC in Norway (Thygesen et al, 2009), and 2 used large representative samples from the United States (Madigan et al 2012; Scharpf, et al 2010). Of the 4 studies conducted in SNF, 3 used large national data sets (Jung et al 2016; Leland et al, 2015 & Wysocki et al, 2015), and one was a single site study (Lee, 2006). Two studies used the Andersen Model of Health Services Utilization (Madigan et al, 2012; Thygesen et al, 2009) to guide the analyses.…”