Effect of inpatient quality of care on functional outcomes in patients with hip fracture

Albert L. Siu, Kenneth S. Boockvar, Joan D. Penrod, R. Sean Morrison, Ethan A. Halm, Ann Litke, Stacey B. Silberzweig, Jeanne Teresi, Katja Ocepek-Welikson, Jay Magaziner

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)862-869
Number of pages8
JournalMedical Care
Volume44
Issue number9
DOIs
StatePublished - Sep 2006

Fingerprint

Quality of Health Care
Hip Fractures
Inpatients
Locomotion
Patient Care
Confidence Intervals
Mortality
Self Care
Medical Records
Cohort Studies
Research Design
Prospective Studies
Interviews
mortality
confidence
Survival
surgery
research planning
mobilization

Keywords

  • Function
  • Hip fracture
  • Process
  • Quality

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

Siu, A. L., Boockvar, K. S., Penrod, J. D., Morrison, R. S., Halm, E. A., Litke, A., ... Magaziner, J. (2006). Effect of inpatient quality of care on functional outcomes in patients with hip fracture. Medical Care, 44(9), 862-869. https://doi.org/10.1097/01.mlr.0000223738.34872.6a

Effect of inpatient quality of care on functional outcomes in patients with hip fracture. / Siu, Albert L.; Boockvar, Kenneth S.; Penrod, Joan D.; Morrison, R. Sean; Halm, Ethan A.; Litke, Ann; Silberzweig, Stacey B.; Teresi, Jeanne; Ocepek-Welikson, Katja; Magaziner, Jay.

In: Medical Care, Vol. 44, No. 9, 09.2006, p. 862-869.

Research output: Contribution to journalArticle

Siu, AL, Boockvar, KS, Penrod, JD, Morrison, RS, Halm, EA, Litke, A, Silberzweig, SB, Teresi, J, Ocepek-Welikson, K & Magaziner, J 2006, 'Effect of inpatient quality of care on functional outcomes in patients with hip fracture', Medical Care, vol. 44, no. 9, pp. 862-869. https://doi.org/10.1097/01.mlr.0000223738.34872.6a
Siu, Albert L. ; Boockvar, Kenneth S. ; Penrod, Joan D. ; Morrison, R. Sean ; Halm, Ethan A. ; Litke, Ann ; Silberzweig, Stacey B. ; Teresi, Jeanne ; Ocepek-Welikson, Katja ; Magaziner, Jay. / Effect of inpatient quality of care on functional outcomes in patients with hip fracture. In: Medical Care. 2006 ; Vol. 44, No. 9. pp. 862-869.
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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.

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