Seniors who break a hip receive the best care in skilled nursing facilities with the most experience handling such fractures, a new study suggests.
Twenty-five cases a year was the magic number, according to lead author Pedro Gozalo, associate professor of health services, policy and practice at the School of Public Health at Brown University in Providence, R.I., and colleagues.
“Even adjusting for a long list of patient risk factors and for important facility characteristics, facilities that had cared for more than two dozen hip fracture patients in the last 12 months were more than twice as likely to successfully discharge patients in a timely manner compared to facilities that had three or less hip fracture admissions,” Gozalo said in a university news release.
The researchers analyzed the medical records of more than 512,000 patients with broken hips, aged 75 and older, who received rehabilitation care at more than 15,400 skilled nursing facilities in the United States between 2000 and 2007.
About 31 percent of the patients were able to return home within a month, but there was wide variation among facilities. Rates were nearly 44 percent at facilities that handled more than 24 cases a year, compared with about 19 percent at facilities that handled one to six cases a year, the findings showed.
The study was published online Oct. 1 in the Journal of the American Geriatrics Society.
“While volume is not a direct measure of post-acute care quality, it appears that it is a good proxy that captures hard-to-measure aspects of quality, like the expertise of the staff, that are clearly associated with an outcome that patients care about: returning home soon and in a condition that allows them to remain at home without further institutionalization in a hospital or a nursing home,” Gozalo explained.
He and his colleagues also found that more than 70 percent of patients who went to a lower-volume skilled nursing facility could have been cared for at a nearby higher-volume facility.
That suggests that patients and their families don’t have enough access to information about the quality of these facilities, Gozalo said.
“Based on our results, it would seem that in addition to any other sources of information and recommendations the family can get, they should definitely ask each facility they are considering what was the number of hip fractures they cared for in the last year,” Gozalo said.
“It’s a basic but very informative predictor of how well their loved one may fare at that facility,” he concluded.
