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    
Abstract/OtherAbstract:
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.
Authors:
Kelly K Richardson; Peter Cram; Mary Vaughan-Sarrazin; Peter J Kaboli
Related Documents :
10111838 - Bond volume rises 19.3%.
10110268 - Irs allows unusual not-for-profit affiliation.
23856438 - Evolution of the use of noninvasive mechanical ventilation in chronic obstructive pulmo...
24668398 - An evaluation of the use of a two-tiered trauma team activation system in a uk major tr...
24305558 - Perception of pharmacovigilance among doctors in a tertiary care hospital: influence of...
21261998 - A role for pharmacists in community-based post-discharge warfarin management: protocol ...
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:  2014-03-06    
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    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
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*
Comments/Corrections
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


Previous Document:  Vascularized Fibular Grafts for Avascular Necrosis After Slipped Capital Femoral Epiphysis: Is Hip P...
Next Document:  Metallobiology of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine neurotoxicity.