Among older patients recovering from a hip fracture, the quality of care that they receive at a post-acute care facility may have a greater impact on their long-term recovery than the care they received at a hospital.
The study, from researchers at the Perelman School of Medicine at the University of Pennsylvania, compared outcome variations in acute and post-acute care facilities among 42,000 Medicare patients.
According to the study, the researchers note that the impact of post-acute care on outcomes, including mortality and mobility, was three to eight times greater than the impact of hospital factors. Overall, nursing home factors explained three times more variation in a patient’s probability of dying at 30 days than hospital factors, seven times more variation in the probability of dying at 180 days, and eight times more variation in the probability of dying or being newly unable to walk at 180 days, explains a media release from the Perelman School of Medicine at the University of Pennsylvania.
“These results highlight the major impact that post-acute care has on basic outcomes such as survival and walking ability among this patient population,” says the study’s lead author Mark D. Neuman, MD, MSc, an assistant professor of Anesthesiology and Critical Care in the Perelman School of Medicine at the University of Pennsylvania, and director of the Penn Center for Perioperative Outcomes Research and Transformation (PCORI).
The cohort study, published recently in Medical Care, a journal of the American Public Health Association, was conducted using Medicare data of older adult, hip fracture patients who were previously nursing home residents between 2005 and 2009. Of the 42,000 patients, 75% were women, 92% were white, and all patients were over 80 years old.
While patient characteristics represented the principal determinants of outcomes after hip fractures, selected hospital and nursing home characteristics were associated with short-and long-term outcomes. Hospital characteristics were not consistently associated with outcomes, while multiple nursing home characteristics did predict outcomes, according to the release.
For instance, per the release, patients treated at a nursing home with low occupancy, more than 150 beds, versus a facility with less than 100 beds, and with historically high mortality rates, were more likely to die or have a new inability to walk after 30 days. Nursing home market concentration and ownership by a multi-facility organization were also modestly associated with 30-day mortality. More, facilities that used more full-time physician extenders and those with a full-time Director of Nursing were modestly associated with 180-day mortality. Nursing homes located within a hospital was also associated with 180-day mortality, the release explains.
“For patients, it sends the simple message that post-acute care, for instance, at a nursing home, may have a major impact on recovery in the long term,” Neuman states.
The researchers note that the next phase of their research is likely to explore the impact on these factors on outcomes for older adults hospitalized for conditions other than hip fractures, as well as the processes within facilities that may help explain the variations in the outcomes observed in this study, per the release.
[Source(s): Perelman School of Medicine at the University of Pennsylvania, Science Daily]