| Fee-based care is important for access to prompt treatment of hip fractures among veterans. | |
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MedLine Citation:
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PMID: 23322188 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Kelly K Richardson; Peter Cram; Mary Vaughan-Sarrazin; Peter J Kaboli |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, U.S. Gov't, Non-P.H.S. Date: 2013-01-16 |
Journal Detail:
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Title: Clinical orthopaedics and related research Volume: 471 ISSN: 1528-1132 ISO Abbreviation: Clin. Orthop. Relat. Res. Publication Date: 2013 Mar |
Date Detail:
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Created Date: 2013-02-05 Completed Date: 2013-04-03 Revised Date: 2013-04-16 |
Medline Journal Info:
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Nlm Unique ID: 0075674 Medline TA: Clin Orthop Relat Res Country: United States |
Other Details:
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Languages: eng Pagination: 1047-53 Citation Subset: AIM; IM |
Affiliation:
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Comprehensive Access & Delivery Research and Evaluation Center, Iowa City VA Healthcare System, Mailstop 152, 601 Highway West, Iowa City, IA 52246, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Age Factors Aged Aged, 80 and over Comorbidity Emergencies Emergency Service, Hospital / economics Fee-for-Service Plans / economics* Female Fracture Fixation / economics* Health Care Costs* Health Services Accessibility / economics* Hip Fractures / economics*, mortality, surgery* Humans Kaplan-Meier Estimate Logistic Models Male Middle Aged Multivariate Analysis Odds Ratio Patient Admission / economics Proportional Hazards Models Residence Characteristics Retrospective Studies Risk Factors Time Factors Time-to-Treatment / economics Treatment Outcome United States United States Department of Veterans Affairs / economics* Veterans* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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