Effect of acute, postacute care on hip fracture outcomes

Editor's Note

For older hip fracture patients, the care they received at a postacute care facility had a three to eight times greater impact on their long-term recovery than the care they received at the hospital, this study finds.

Nursing home factors explained three times more variation in the odds of dying at 30 days than hospital factors, seven times more variation in the odds of dying at 180 days, and eight times more variation in the odds of dying or being newly unable to walk at 180 days.

Multiple nursing home characteristics predicted outcomes, including bed count, chain membership, and performance on certain quality measures.

Hospital characteristics, such as nurse-to-bed ratio, mean hospital nurse skill mix, and hospital for-profit status were not consistently associated with outcomes.

Objective: To quantify the contribution of acute versus postacute care factors to survival and functional outcomes after hip fracture. Design, Setting, and Participants: Retrospective cohort study using Medicare data; subjects included previously ambulatory nursing home residents hospitalized for hip fracture between 2005 and 2009.