TY - JOUR
T1 - Effect of inpatient quality of care on functional outcomes in patients with hip fracture
AU - Siu, Albert L.
AU - Boockvar, Kenneth S.
AU - Penrod, Joan D.
AU - Morrison, R. Sean
AU - Halm, Ethan A.
AU - Litke, Ann
AU - Silberzweig, Stacey B.
AU - Teresi, Jeanne
AU - Ocepek-Welikson, Katja
AU - Magaziner, Jay
PY - 2006/9
Y1 - 2006/9
N2 - OBJECTIVES: We sought to examine the relationship between functional outcome and process of care for patients with hip fracture. RESEARCH DESIGN AND PARTICIPANTS: We undertook a prospective cohort study in 4 hospitals of 554 patients treated with surgery for hip fracture. MEASUREMENTS: Information on patient characteristics and processes of hospital care collected from the medical record, interviews, and bedside observations. Follow-up information obtained at 6 months on function (using the Functional Independence Measure [FIM]), survival, and readmission. RESULTS: Individual processes of care were generally not associated with adjusted outcomes. A scale of 9 processes related to mobilization was associated with improved adjusted locomotion (P = 0.006), self care (P = 0.022), and transferring (P = 0.007) at 2 months, but the benefits were smaller and not significant by 6 months. These processes were not associated with mortality. The predicted value for the FIM locomotion measure (range, 2-14) at 2 months was 5.9 (95% confidence interval 5.4-6.4) for patients at the 10th percentile of performance on these processes compared with 7.1 (95% confidence interval 6.6, 7.6) at the 90th percentile. Patients who experienced no hospital complications and no readmissions retained the benefits in locomotion at 6 months. Anticoagulation processes were associated with improved transferring at 2 months (P = 0.046) but anticoagulation and other processes of care were not otherwise associated with improved function. DISCUSSION: Our findings indicate the need to attend to all steps in the care of patients with hip fracture. Additionally, functional outcomes were more sensitive markers of improved process of care, compared with 6-month mortality, in the case of hip fracture.
AB - OBJECTIVES: We sought to examine the relationship between functional outcome and process of care for patients with hip fracture. RESEARCH DESIGN AND PARTICIPANTS: We undertook a prospective cohort study in 4 hospitals of 554 patients treated with surgery for hip fracture. MEASUREMENTS: Information on patient characteristics and processes of hospital care collected from the medical record, interviews, and bedside observations. Follow-up information obtained at 6 months on function (using the Functional Independence Measure [FIM]), survival, and readmission. RESULTS: Individual processes of care were generally not associated with adjusted outcomes. A scale of 9 processes related to mobilization was associated with improved adjusted locomotion (P = 0.006), self care (P = 0.022), and transferring (P = 0.007) at 2 months, but the benefits were smaller and not significant by 6 months. These processes were not associated with mortality. The predicted value for the FIM locomotion measure (range, 2-14) at 2 months was 5.9 (95% confidence interval 5.4-6.4) for patients at the 10th percentile of performance on these processes compared with 7.1 (95% confidence interval 6.6, 7.6) at the 90th percentile. Patients who experienced no hospital complications and no readmissions retained the benefits in locomotion at 6 months. Anticoagulation processes were associated with improved transferring at 2 months (P = 0.046) but anticoagulation and other processes of care were not otherwise associated with improved function. DISCUSSION: Our findings indicate the need to attend to all steps in the care of patients with hip fracture. Additionally, functional outcomes were more sensitive markers of improved process of care, compared with 6-month mortality, in the case of hip fracture.
KW - Function
KW - Hip fracture
KW - Process
KW - Quality
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U2 - 10.1097/01.mlr.0000223738.34872.6a
DO - 10.1097/01.mlr.0000223738.34872.6a
M3 - Article
C2 - 16932138
AN - SCOPUS:33748121929
SN - 0025-7079
VL - 44
SP - 862
EP - 869
JO - Medical Care
JF - Medical Care
IS - 9
ER -