Walter P Wodchis1,2,3, Zeynep Or4,5, Carl Rudolf Blankart6,7,8, Femke Atsma9, Nils Janlov10, Yu Qing Bai1,3, Anne Penneau4,5, Mina Arvin9, Hannah Knight11, Kristen Riley12, Jose F Figueroa12, Irene Papanicolas13. 1. Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada. 2. Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada. 3. ICES, Toronto, Ontario, Canada. 4. Institute for Research and Documentation in Health Economics (IRDES), Paris, France. 5. Department of Economics (LEDa), University Dauphine PSL, Paris, France. 6. KPM Center for Public Management, University of Bern, Bern, Switzerland. 7. Swiss Institute of Translational and Entrepreneurial Medicine, Bern, Switzerland. 8. Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany. 9. Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, The Netherlands. 10. The Swedish Agency for Health and Care Services Analysis, Stockholm, Sweden. 11. The Health Foundation, London, UK. 12. Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. 13. Department of Health Policy, London School of Economics, London, UK.
Abstract
OBJECTIVE: The objectives of this study are to compare the relative use of different postacute care settings in different countries and to compare three important outcomes as follows: total expenditure, total days of care in different care settings, and overall longevity over a 1-year period following a hip fracture. DATA SOURCES: We used administrative data from hospitals, institutional and home-based long-term care (LTC), physician visits, and medications compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) from five countries as follows: Canada, France, Germany, the Netherlands, and Sweden. DATA EXTRACTION METHODS: Data were extracted from existing administrative data systems in each participating country. STUDY DESIGN: This is a retrospective cohort study of all individuals admitted to acute care for hip fracture. Descriptive comparisons were used to examine aggregate institutional and home-based postacute care. Care trajectories were created to track sequential care settings after acute-care discharge through institutional and community-based care in three countries where detailed information allowed. Comparisons in patient characteristics, utilization, and costs were made across these trajectories and countries. PRINCIPAL FINDINGS: Across five countries with complete LTC data, we found notable variations with Germany having the highest days of home-based services with relatively low costs, while Sweden incurred the highest overall expenditures. Comparisons of trajectories found that France had the highest use of inpatient rehabilitation. Germany was most likely to discharge hip fracture patients to home. Over 365 days, France averaged the highest number of days in institution with 104, Canada followed at 94, and Germany had just 87 days of institutional care on average. CONCLUSION: In this comparison of LTC services following a hip fracture, we found international differences in total use of institutional and noninstitutional care, longevity, and total expenditures. There exist opportunities to organize postacute care differently to maximize independence and mitigate costs.
OBJECTIVE: The objectives of this study are to compare the relative use of different postacute care settings in different countries and to compare three important outcomes as follows: total expenditure, total days of care in different care settings, and overall longevity over a 1-year period following a hip fracture. DATA SOURCES: We used administrative data from hospitals, institutional and home-based long-term care (LTC), physician visits, and medications compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) from five countries as follows: Canada, France, Germany, the Netherlands, and Sweden. DATA EXTRACTION METHODS: Data were extracted from existing administrative data systems in each participating country. STUDY DESIGN: This is a retrospective cohort study of all individuals admitted to acute care for hip fracture. Descriptive comparisons were used to examine aggregate institutional and home-based postacute care. Care trajectories were created to track sequential care settings after acute-care discharge through institutional and community-based care in three countries where detailed information allowed. Comparisons in patient characteristics, utilization, and costs were made across these trajectories and countries. PRINCIPAL FINDINGS: Across five countries with complete LTC data, we found notable variations with Germany having the highest days of home-based services with relatively low costs, while Sweden incurred the highest overall expenditures. Comparisons of trajectories found that France had the highest use of inpatient rehabilitation. Germany was most likely to discharge hip fracture patients to home. Over 365 days, France averaged the highest number of days in institution with 104, Canada followed at 94, and Germany had just 87 days of institutional care on average. CONCLUSION: In this comparison of LTC services following a hip fracture, we found international differences in total use of institutional and noninstitutional care, longevity, and total expenditures. There exist opportunities to organize postacute care differently to maximize independence and mitigate costs.
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Authors: Peter Cram; Laura A Hatfield; Pieter Bakx; Amitava Banerjee; Christina Fu; Michal Gordon; Renaud Heine; Nicole Huang; Dennis Ko; Lisa M Lix; Victor Novack; Laura Pasea; Feng Qiu; Therese A Stukel; Carin Uyl de Groot; Lin Yan; Bruce Landon Journal: BMJ Date: 2022-05-04