Andrew J Schoenfeld1, Michael J Weaver, Robyn K Power, Mitchel B Harris. 1. *Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and †Robert Wood Johnson Clinical Scholars Program, Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Abstract
OBJECTIVES: To determine whether hospital processes and hospital quality associated with the care of femoral neck fractures were significantly altered by the implementation of healthcare reform in Massachusetts. DESIGN: Pre-post retrospective study. SETTING: Massachusetts Statewide Inpatient Dataset (SID). PATIENTS/PARTICIPANTS: Patients treated for femoral neck fracture (n = 23,485) in the periods prehealth (2003-06) and posthealth reform (2008-10). INTERVENTION: Differences in hospital processes for fracture care and quality measures were assessed for the periods before and after health reform. OUTCOME MEASUREMENTS: Differences in hospital processes for fracture care (type of surgical intervention, length of stay, and discharge disposition) and quality metrics [mortality, complications, re-operation, and failure to rescue (FTR)] in the periods before and after health reform were assessed using regression techniques to adjust for differences in case mix and the type of surgical intervention. RESULTS: There were no significant differences in the type of surgical intervention performed prereform and postreform (P = 0.27). After adjustment for case mix and surgical intervention, length of stay was significantly reduced {regression coefficient -0.07 [95% confidence interval (CI), -0.09 to -0.06]} as were the odds of FTR [odds ratio 0.73 (95% CI, 0.59-0.92)]. Discharges to skilled nursing facilities significantly increased in the postreform period [relative risk ratio 1.15 (95% CI, 1.03-1.30)]. Findings associated with FTR were driven by changes in the detection of surveillance sensitive complications. CONCLUSIONS: Health reform in Massachusetts led to no clinically meaningful differences in hospital processes for femoral neck fracture care. Although some differences in quality measures were noted, these cannot necessarily be attributed to health care reform.
OBJECTIVES: To determine whether hospital processes and hospital quality associated with the care of femoral neck fractures were significantly altered by the implementation of healthcare reform in Massachusetts. DESIGN: Pre-post retrospective study. SETTING: Massachusetts Statewide Inpatient Dataset (SID). PATIENTS/PARTICIPANTS: Patients treated for femoral neck fracture (n = 23,485) in the periods prehealth (2003-06) and posthealth reform (2008-10). INTERVENTION: Differences in hospital processes for fracture care and quality measures were assessed for the periods before and after health reform. OUTCOME MEASUREMENTS: Differences in hospital processes for fracture care (type of surgical intervention, length of stay, and discharge disposition) and quality metrics [mortality, complications, re-operation, and failure to rescue (FTR)] in the periods before and after health reform were assessed using regression techniques to adjust for differences in case mix and the type of surgical intervention. RESULTS: There were no significant differences in the type of surgical intervention performed prereform and postreform (P = 0.27). After adjustment for case mix and surgical intervention, length of stay was significantly reduced {regression coefficient -0.07 [95% confidence interval (CI), -0.09 to -0.06]} as were the odds of FTR [odds ratio 0.73 (95% CI, 0.59-0.92)]. Discharges to skilled nursing facilities significantly increased in the postreform period [relative risk ratio 1.15 (95% CI, 1.03-1.30)]. Findings associated with FTR were driven by changes in the detection of surveillance sensitive complications. CONCLUSIONS: Health reform in Massachusetts led to no clinically meaningful differences in hospital processes for femoral neck fracture care. Although some differences in quality measures were noted, these cannot necessarily be attributed to health care reform.
Authors: Jose F Figueroa; Kathryn E Horneffer; Kristen Riley; Olukorede Abiona; Mina Arvin; Femke Atsma; Enrique Bernal-Delgado; Carl Rudolf Blankart; Nicholas Bowden; Sarah Deeny; Francisco Estupiñán-Romero; Robin Gauld; Tonya Moen Hansen; Philip Haywood; Nils Janlov; Hannah Knight; Luca Lorenzoni; Alberto Marino; Zeynep Or; Leila Pellet; Duncan Orlander; Anne Penneau; Andrew J Schoenfeld; Kosta Shatrov; Kjersti Eeg Skudal; Mai Stafford; Onno van de Galien; Kees van Gool; Walter P Wodchis; Marit Tanke; Ashish K Jha; Irene Papanicolas Journal: Health Serv Res Date: 2021-12 Impact factor: 3.402