Journal article
Fee-based Care is Important for Access to Prompt Treatment of Hip Fractures Among Veterans
Clinical orthopaedics and related research, Vol.471(3), pp.1047-1053
03/2013
DOI: 10.1007/s11999-013-2783-3
PMCID: PMC3563825
PMID: 23322188
Abstract
ackground: 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.
Details
- Title: Subtitle
- Fee-based Care is Important for Access to Prompt Treatment of Hip Fractures Among Veterans
- Creators
- Kelly K Richardson - Comprehensive Access & Delivery Research and Evaluation Center, Iowa City VA Healthcare System, Mailstop 152, 601 Highway West, Iowa City, IA 52246 USAPeter Cram - Comprehensive Access & Delivery Research and Evaluation Center, Iowa City VA Healthcare System, Mailstop 152, 601 Highway West, Iowa City, IA 52246 USAMary Vaughan-Sarrazin - Comprehensive Access & Delivery Research and Evaluation Center, Iowa City VA Healthcare System, Mailstop 152, 601 Highway West, Iowa City, IA 52246 USAPeter J Kaboli - Comprehensive Access & Delivery Research and Evaluation Center, Iowa City VA Healthcare System, Mailstop 152, 601 Highway West, Iowa City, IA 52246 USA
- Resource Type
- Journal article
- Publication Details
- Clinical orthopaedics and related research, Vol.471(3), pp.1047-1053
- DOI
- 10.1007/s11999-013-2783-3
- PMID
- 23322188
- PMCID
- PMC3563825
- NLM abbreviation
- Clin Orthop Relat Res
- ISSN
- 0009-921X
- eISSN
- 1528-1132
- Publisher
- Springer-Verlag; New York
- Language
- English
- Date published
- 03/2013
- Academic Unit
- Health Management and Policy; Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984063138202771
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