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Mortality and Locomotion 6 Months After Hospitalization for Hip Fracture
Risk Factors and Risk-Adjusted Hospital Outcomes
Edward L. Hannan, PhD;
Jay Magaziner, PhD;
Jason J. Wang, MA,MS;
Elizabeth A. Eastwood, PhD;
Stacey B. Silberzweig, MS,RD;
Marvin Gilbert, MD;
R. Sean Morrison, MD;
Mary Ann McLaughlin, MD,MPH;
Gretchen M. Orosz, MD;
Albert L. Siu, MD,MSPH
JAMA. 2001;285:2736-2742.
Context Hip fracture is a common clinical problem that leads to considerable mortality and disability. A need exists for a practical means to monitor and improve outcomes, including function, for patients with hip fracture.
Objectives To identify and compare the importance of significant prefracture predictors of functional status and mortality at 6 months for patients hospitalized with hip fracture and to compare risk-adjusted outcomes for hospitals providing initial care.
Design Prospective study with data obtained from medical records and through structured interviews with patients and proxies.
Setting and Participants A total of 571 adults aged 50 years or older with hip fracture who were admitted to 4 New York, NY, metropolitan hospitals between August 1997 and August 1998.
Main Outcome Measures In-hospital and 6-month mortality; locomotion at 6 months; and adverse outcomes at 6 months, defined as death or needing assistance to ambulate, compared by hospital, adjusting for patient risk factors.
Results The in-hospital mortality rate was 1.6%. At 6 months, the mortality rate was 13.5%, and another 12.8% needed total assistance to ambulate. Laboratory values were strong predictors of mortality but were not significantly associated with locomotion. Age and prefracture residence at a nursing home were significant predictors of locomotion (P = .02 for both) but were not significantly associated with mortality. Adjustment for baseline characteristics either substantially augmented or diminished interhospital differences in outcomes. Two hospitals had 1 outcome (functional status or mortality) that was significantly worse than the overall mean while the other outcome was nonsignificantly better than average.
Conclusions Mortality and functional status ideally should be considered both together and individually to distinguish effects limited to one or the other outcome. Hospital performance for these 2 measures may differ substantially after adjustment, probably because different processes of care are important to each outcome.
Author Affiliations: Department of Health Policy, Management, and Behavior, University at Albany—State University of New York, School of Public Health, Rensselaer, NY (Dr Hannan); Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland at Baltimore (Dr Magaziner); Departments of Health Policy (Mr Wang and Drs McLaughlin and Siu), Rehabilitation Medicine (Dr Eastwood), Orthopaedics (Dr Gilbert), Geriatrics and Adult Development (Drs Morrison, McLaughlin, Orosz, and Siu and Ms Silberzweig), and Medicine (Drs McLaughlin, Orosz, and Siu), Mount Sinai School of Medicine, New York, NY.
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