|Fee-based care is important for access to prompt treatment of hip fractures among veterans.|
|PMID: 23322188 Owner: NLM Status: MEDLINE|
|BACKGROUND: Hip fracture is a medical emergency for which delayed treatment increases risk of disability and death. In emergencies, veterans without access to a Veterans Administration (VA) hospital may be admitted to non-VA hospitals under fee-based (NVA-FB) care paid by the VA. The affect of NVA-FB care for treatment and outcomes of hip fractures is unknown.
QUESTIONS/PURPOSES: This research seeks to answer three questions: (1) What patient characteristics determine use of VA versus NVA-FB hospitals for hip fracture? (2) Does time between admission and surgery differ by hospital (VA versus NVA-FB)? (3) Does mortality differ by hospital?
METHODS: Veterans admitted for hip fractures to VA (n = 9308) and NVA-FB (n = 1881) hospitals from 2003 to 2008 were identified. Primary outcomes were time to surgery and death. Logistic regression identified patient characteristics associated with NVA-FB hospital admissions; differences in time to surgery and death were evaluated using Cox proportional hazards regression, controlling for patient covariates.
RESULTS: Patients admitted to NVA-FB hospitals were more likely to be younger, have service-connected disabilities, and live more than 50 miles from a VA hospital. Median days to surgery were less for NVA-FB admissions compared with VA admissions (1 versus 3 days, respectively). NVA-FB admissions were associated with 21% lower relative risk of death within 1 year compared with VA hospital admissions.
CONCLUSIONS: For veterans with hip fractures, NVA-FB hospital admission was associated with shorter time to surgery and lower 1-year mortality. These findings suggest fee-based care, especially for veterans living greater distances from VA hospitals, may improve access to care and health outcomes.
LEVEL OF EVIDENCE: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
|Kelly K Richardson; Peter Cram; Mary Vaughan-Sarrazin; Peter J Kaboli|
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|Type: Comparative Study; Journal Article; Research Support, U.S. Gov't, Non-P.H.S. Date: 2013-01-16|
|Title: Clinical orthopaedics and related research Volume: 471 ISSN: 1528-1132 ISO Abbreviation: Clin. Orthop. Relat. Res. Publication Date: 2013 Mar|
|Created Date: 2013-02-05 Completed Date: 2013-04-03 Revised Date: 2013-06-14|
Medline Journal Info:
|Nlm Unique ID: 0075674 Medline TA: Clin Orthop Relat Res Country: United States|
|Languages: eng Pagination: 1047-53 Citation Subset: AIM; IM|
|Comprehensive Access & Delivery Research and Evaluation Center, Iowa City VA Healthcare System, Mailstop 152, 601 Highway West, Iowa City, IA 52246, USA.|
|APA/MLA Format Download EndNote Download BibTex|
Aged, 80 and over
Emergency Service, Hospital / economics
Fee-for-Service Plans / economics*
Fracture Fixation / economics*
Health Care Costs*
Health Services Accessibility / economics*
Hip Fractures / economics*, mortality, surgery*
Patient Admission / economics
Proportional Hazards Models
Time-to-Treatment / economics
United States Department of Veterans Affairs / economics*
|Clin Orthop Relat Res. 2013 Jun;471(6):2036
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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