Get access

Patient Relocation in the 6 Months After Hip Fracture: Risk Factors for Fragmented Care

Authors

  • Kenneth S. Boockvar MD, MS,

    1. From the *Geriatric Research, Education, and Clinical Center, Bronx Veterans Affairs Medical Center, Bronx, New YorkDepartments of Geriatrics and Adult Development, Health Policy, and §Medicine, Mount Sinai School of Medicine, New YorkDepartment of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland at Baltimore, Baltimore, MarylandDepartment of Orthopedic Surgery, New York University School of Medicine, New York.
    Search for more papers by this author
  • Ann Litke MA,

    1. From the *Geriatric Research, Education, and Clinical Center, Bronx Veterans Affairs Medical Center, Bronx, New YorkDepartments of Geriatrics and Adult Development, Health Policy, and §Medicine, Mount Sinai School of Medicine, New YorkDepartment of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland at Baltimore, Baltimore, MarylandDepartment of Orthopedic Surgery, New York University School of Medicine, New York.
    Search for more papers by this author
  • Joan D. Penrod PhD,

    1. From the *Geriatric Research, Education, and Clinical Center, Bronx Veterans Affairs Medical Center, Bronx, New YorkDepartments of Geriatrics and Adult Development, Health Policy, and §Medicine, Mount Sinai School of Medicine, New YorkDepartment of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland at Baltimore, Baltimore, MarylandDepartment of Orthopedic Surgery, New York University School of Medicine, New York.
    Search for more papers by this author
  • Ethan A. Halm MD, MPH,

    1. From the *Geriatric Research, Education, and Clinical Center, Bronx Veterans Affairs Medical Center, Bronx, New YorkDepartments of Geriatrics and Adult Development, Health Policy, and §Medicine, Mount Sinai School of Medicine, New YorkDepartment of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland at Baltimore, Baltimore, MarylandDepartment of Orthopedic Surgery, New York University School of Medicine, New York.
    Search for more papers by this author
  • R. Sean Morrison MD,

    1. From the *Geriatric Research, Education, and Clinical Center, Bronx Veterans Affairs Medical Center, Bronx, New YorkDepartments of Geriatrics and Adult Development, Health Policy, and §Medicine, Mount Sinai School of Medicine, New YorkDepartment of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland at Baltimore, Baltimore, MarylandDepartment of Orthopedic Surgery, New York University School of Medicine, New York.
    Search for more papers by this author
  • Stacey B. Silberzweig MS, RD,

    1. From the *Geriatric Research, Education, and Clinical Center, Bronx Veterans Affairs Medical Center, Bronx, New YorkDepartments of Geriatrics and Adult Development, Health Policy, and §Medicine, Mount Sinai School of Medicine, New YorkDepartment of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland at Baltimore, Baltimore, MarylandDepartment of Orthopedic Surgery, New York University School of Medicine, New York.
    Search for more papers by this author
  • Jay Magaziner PhD,

    1. From the *Geriatric Research, Education, and Clinical Center, Bronx Veterans Affairs Medical Center, Bronx, New YorkDepartments of Geriatrics and Adult Development, Health Policy, and §Medicine, Mount Sinai School of Medicine, New YorkDepartment of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland at Baltimore, Baltimore, MarylandDepartment of Orthopedic Surgery, New York University School of Medicine, New York.
    Search for more papers by this author
  • Kenneth Koval MD,

    1. From the *Geriatric Research, Education, and Clinical Center, Bronx Veterans Affairs Medical Center, Bronx, New YorkDepartments of Geriatrics and Adult Development, Health Policy, and §Medicine, Mount Sinai School of Medicine, New YorkDepartment of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland at Baltimore, Baltimore, MarylandDepartment of Orthopedic Surgery, New York University School of Medicine, New York.
    Search for more papers by this author
  • Albert L. Siu MD, MSPH

    1. From the *Geriatric Research, Education, and Clinical Center, Bronx Veterans Affairs Medical Center, Bronx, New YorkDepartments of Geriatrics and Adult Development, Health Policy, and §Medicine, Mount Sinai School of Medicine, New YorkDepartment of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland at Baltimore, Baltimore, MarylandDepartment of Orthopedic Surgery, New York University School of Medicine, New York.
    Search for more papers by this author

  • This project was supported by Grants HS09973 and U18HS09459-0 from the Agency for Healthcare Research and Quality. The Mary and David Hoar Fellowship of the New York Community Trust and the New York Academy of Medicine (Dr. Boockvar), the National Institute on Aging (Midcareer Investigator Award to Dr. Siu and Mentored Clinical Scientist Development Award to Dr. Morrison), the Paul Beeson Faculty Scholars Program (Dr. Morrison), and the Robert Wood Johnson Generalist Physician Faculty Scholars Program (Dr. Halm) provided additional support.

Kenneth Boockvar, MD, MS, Bronx Veterans Affairs Medical Center, 130 W. Kingsbridge Road, Rm 4 A-17, Bronx, NY 10468. E-mail: kenneth.boockvar@mssm.edu

Abstract

Objectives: To describe the incidence and patterns of patient relocation after hip fracture, identify factors associated with relocation, and examine effect of relocation on outcomes.

Design: Prospective cohort study.

Setting: Four hospitals in the New York metropolitan area.

Participants: A total of 562 patients hospitalized for hip fracture discharged alive in 1997 to 1998.

Measurements: Patient characteristics and hospital course were ascertained using patient or surrogate interview, research nurse assessment, and medical record review. Patient location was ascertained at five time points using patient or surrogate interview, and hospital readmissions were identified using New York state and hospital admission databases. Mobility was measured using patient or surrogate report using the Functional Independence Measure.

Results: During 6 months of follow-up, the mean number of relocations per patient±standard deviation was 3.5±1.5 (range 2–10). Forty-one percent of relocations were between home and hospital, 36% between rehabilitation or nursing facility and hospital, 17% between rehabilitation or nursing facility and home, and 4% between two rehabilitation/nursing facilities. In a Poisson regression model that controlled for patient characteristics, hospital course, and length of follow-up, factors associated with relocation (P<.05) were absence of dementia, in-hospital delirium, one or more new impairments at hospital discharge, hospital discharge other than to home, and not living at home alone prefracture. Relocation was not significantly associated with immobility or mortality at 6 months (odds ratio=1.14, 95% confidence interval=0.97–1.35).

Conclusion: Subgroups of patients with elevated risk of relocation after hip fracture may be target groups for intensive care coordination and care planning interventions.

Ancillary