Mary Wiktorowicz

Economic implications of hip fracture: health service use, institutional care and cost in Canada.

Abstract: As the burden of illness associated with hip fracture extends beyond the initial hospitalization, a longitudinal 1 year cohort study was used to analyze levels of health service use, institutional care and their associated costs, and to examine patient and residency factors contributing to overall 1 year cost. Patients in the study were aged 50 year and over, and had been admitted to an acute care facility for hip fracture in the Hamilton–Wentworth region of Canada from 1 April 1995 to 31 March 1996. Health care resources assessed included initial hospitalization, rehospitalization, rehabilitation, chronic care, home care, long-term care (LTC) and informal care. Regression analysis was used to determine the effects of age, gender, residence, survival and days of follow-up on 1 year cost. The mean 1 year cost of hip fracture for the 504 study patients was 26.527 Canadian dollars (95% Cl:

Mortality, Independence in Living, and Re-fracture, One Year Following Hip Fracture in Canadians

24.564–

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28.490). One year costs were significantly different for patients who returned to the community (

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21.385), versus those who were transferred to (

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44.156), or readmitted to LTC facilities (

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33.729) (p<0.001). Initial hospitalization represented 58% of 1 year cost for community-dwelling patients, compared with 27% for LTC residents. Only 59.4% of community-dwelling patients resided in the community 1 year following hip fracture, and 5.6% of patients who survived their first fracture experienced a subsequent hip fracture. Linear regression indicated place of residence, age and survival were all important contributors to 1 year cost (p<0.001). While the average 1 year cost of care was

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26.527, the overall cost varied depending on a patient”s place of residence, age, and survival to 1 year. Annual economic implications of hip fracture in Canada are

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650 million and are expected to rise to

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2.4 billion by 2041.

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Abstract Purposes: 1.To determine the one year mortality, institutionalization, and re-fracture rates following hip fractures in Canadians. 2.To compare post-fracture outcomes between those who fracture while living in institutions versus living in the community. 3.To compare Canadian data with that of other countries. Methods: an observational study involved a cohort of 527 men and women aged 50 and older with hip fractures identified by ICD-9 codes. Subjects were contacted 12 months following acute care discharge between April 1, 1995 and March 21, 1996, from four hospitals in Hamilton Ontario. Data on mortality, place of residence, and re-fractures were obtained by telephone contact and searches of re-hospitalization records. Results: data were obtained on 504 of the 527 Patients. Overall, 25.2% of patients died within one year. Among 399 Patients coming from the community, 20.5% died, 5.2% sustained another hip fracture and 19.0% (24.3% of survivors) were institutionalized. Among the 105 patients from institutions, only one returned to the community, 39.0% died, and 5.7% refractured a hip. Of those returning to the community, 62.4% had used home care services for a mean of 154 days (95% CI=129,179). Osteoporosis was noted in the hospital records for only nine of 141 Patients (1.7%). None had bisphosphonates or hormone replacement recorded and only 25 (17.7%) had vitamin D or calcium recorded as discharge medications. Interpretation: rates of mortality and loss of independence in living were similar to those found in other studies whereas hip re-fracture rates were higher (p