Total length of stay, costs and outcomes at final discharge for admitted patients with hip fracture: linked episode data for Australian veterans and war widows

Abstract

Background and aim: To identify the total duration of hospital stay, total hospital costs and outcomes at final discharge for a series of Australian patients with hip fracture.

Methods: The study type was retrospective cohort study using episode linkage within and between administrative databases. Study population is 2552 Australian veterans and war widows with primary diagnosis of hip fracture (International Classification of Diseases 10th revision, S 72.0-S 72.2) and hospital separation dates between 1 July 2008 and 30 June 2009. The unique identifying number within Department of Veterans' Affairs health service databases was used to link records for relevant hospital episodes as defined. Additional linkages were made with data for residential care admissions and date of death.

Results: Mean length of stay (LOS) for unlinked acute episodes was 11.1 days, and cost of hospitalisation was A$ 13,095. Fifty-one per cent of these episodes ended with transfer to ongoing hospital care, 9.5% were discharged to residential aged care (RAC), in-hospital mortality was 6.5%, and 23% were discharged to 'usual residence'. When data for all continuous episodes following hip fracture were combined, mean LOS was 30.8 days, costs were A$ 26,023 and in-hospital mortality was 11.1%. Additional linkage with RAC records identified 38% of final discharges to RAC facilities with 44% of patients returning to independent living.

Conclusion: For complex conditions such as hip fracture, a process of patient-specific episode linkage is required to identify accurately hospital LOS, costs and patient outcomes.

Keywords: hip fracture; hospital cost; length of stay; outcome assessment; record linkage.