Document Detail

Fee-based care is important for access to prompt treatment of hip fractures among veterans.
MedLine Citation:
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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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2013-01-16
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  471     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-05     Completed Date:  2013-04-03     Revised Date:  2014-05-26    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1047-53     Citation Subset:  AIM; IM    
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MeSH Terms
Age Factors
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*
Kaplan-Meier Estimate
Logistic Models
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*
Grant Support
Comment In:
Clin Orthop Relat Res. 2013 Jun;471(6):2036   [PMID:  23546849 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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