Kristen B Pitzul1, Walter P Wodchis2,3,4, Hans J Kreder2,5, Michael W Carter6, Susan B Jaglal2,3,4,7. 1. Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, M5T2M6, Canada. kristen.pitzul@mail.utoronto.ca. 2. Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, M5T2M6, Canada. 3. Institute for Clinical Evaluative Sciences, G1 06 2075 Bayview Avenue, Toronto, Ontario, M4N3M5, Canada. 4. Toronto Rehabilitation Institute-University Health Network, 190 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada. 5. Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N3M5, Canada. 6. Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, Ontario, M5S3G8, Canada. 7. Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, Ontario, M5G1V7, Canada.
Abstract
This study determines outcomes and costs of similar hip fracture patients that were discharged from hospital to a rehabilitation facility or to the community within 1 year. Community patients had worse outcomes and lower costs compared to rehabilitation facility patients. This study contributes to understanding hip fracture quality of care. PURPOSE: The purpose of this study is to determine the impact on mortality and rehospitalization, as well as health system cost, of similar hip fracture patients being discharged to an inpatient rehabilitation facility or directly to the community within 1 year in Ontario, Canada. METHODS: This was a retrospective study of a propensity-matched cohort completed from the health system perspective. Administrative databases were used to identify and match two groups of older adults (total n = 18,773) discharged alive from acute care for hip fracture repair: patients discharged to inpatient rehabilitation were matched to patients discharged to the community. RESULTS: A higher proportion of patients discharged to the community (27-42%) died or were rehospitalized (SDhighipr = 0.21, SDlowipr = 0.33) and had substantially lower health system costs (SDhighipr = 0.65, SDlowipr = 0.42) up to 1 year post-acute discharge compared to similar patients discharged to inpatient rehabilitation facilities (IPR) (10-11%). CONCLUSIONS: This study demonstrates that similar hip fracture patients are discharged to different post-acute settings (i.e., home-based rehabilitation and inpatient rehabilitation) and have different outcomes, thereby calling into question the appropriateness of post-acute rehabilitation delivery in Ontario, Canada. Future research should focus on determining how trade-offs in resource allocation between settings would impact patient outcomes.
This study determines outcomes and costs of similar hip fracturepatients that were discharged from hospital to a rehabilitation facility or to the community within 1 year. Community patients had worse outcomes and lower costs compared to rehabilitation facility patients. This study contributes to understanding hip fracture quality of care. PURPOSE: The purpose of this study is to determine the impact on mortality and rehospitalization, as well as health system cost, of similar hip fracturepatients being discharged to an inpatient rehabilitation facility or directly to the community within 1 year in Ontario, Canada. METHODS: This was a retrospective study of a propensity-matched cohort completed from the health system perspective. Administrative databases were used to identify and match two groups of older adults (total n = 18,773) discharged alive from acute care for hip fracture repair: patients discharged to inpatient rehabilitation were matched to patients discharged to the community. RESULTS: A higher proportion of patients discharged to the community (27-42%) died or were rehospitalized (SDhighipr = 0.21, SDlowipr = 0.33) and had substantially lower health system costs (SDhighipr = 0.65, SDlowipr = 0.42) up to 1 year post-acute discharge compared to similar patients discharged to inpatient rehabilitation facilities (IPR) (10-11%). CONCLUSIONS: This study demonstrates that similar hip fracturepatients are discharged to different post-acute settings (i.e., home-based rehabilitation and inpatient rehabilitation) and have different outcomes, thereby calling into question the appropriateness of post-acute rehabilitation delivery in Ontario, Canada. Future research should focus on determining how trade-offs in resource allocation between settings would impact patient outcomes.
Authors: L Beaupre; B Sobolev; P Guy; J D Kim; L Kuramoto; K J Sheehan; J M Sutherland; E Harvey; S N Morin Journal: Osteoporos Int Date: 2019-04-01 Impact factor: 4.507
Authors: Katie J Sheehan; Toby O Smith; Finbarr C Martin; Antony Johansen; Avril Drummond; Lauren Beaupre; Jay Magaziner; Julie Whitney; Ami Hommel; Ian D Cameron; Iona Price; Catherine Sackley Journal: Phys Ther Date: 2019-03-01
Authors: Caitlin McArthur; Ahreum Lee; Hajar Abu Alrob; Jonathan D Adachi; Lora Giangregorio; Lauren E Griffith; Suzanne Morin; Lehana Thabane; George Ioannidis; Justin Lee; William D Leslie; Alexandra Papaioannou Journal: Arch Osteoporos Date: 2022-02-04 Impact factor: 2.617
Authors: Ahreum Lee; Caitlin McArthur; George Ioannidis; Jonathan D Adachi; Lauren E Griffith; Lehana Thabane; Lora Giangregorio; Suzanne N Morin; William D Leslie; Justin Lee; Alexandra Papaioannou Journal: JBMR Plus Date: 2022-09-28