Long-term Impact of Hip Fracture on the Use of Healthcare Resources: a Population-Based Study

Abstract

Objectives: To assess the impact of hip fracture (HF) on health care expenditures and resource use.

Design: Observational, retrospective study. An administrative registry was used to obtain sociodemographic, clinical, and expenditure data of patients treated in centers all over Catalonia (North-East Spain).

Setting and participants: Male and female patients aged 65 years or older admitted to a Catalonian hospital due to hip fracture (HF) between January 1 2012, and December 31, 2016.

Measures: The study data set included the expenditure and frequency of using nonemergency transport, rehabilitation, skilled nursing facility, specialist visits, admissions to the emergency department, hospitalization, pharmacy, and primary care. The patient status at each time point included living at home, staying in hospital, staying in a skilled nursing facility, institutionalized in a nursing home, and death.

Results: The record included 38,628 patients (74.4% female) with a mean [standard deviation (SD)] age of 84.9 (7.07) years. The average expenditure per patient during the first year after hospital admission was €11,721.06, the index hospitalization being the leading expenditure (€4740.29). Expenditures related to hospitalization and skilled nursing facility remained higher than preinjury throughout the 3 years following HF. Three years after the index admission, 44.9% of patients had died, 39.7% were living in their homes, 14.2% were in a nursing home, 0.9% were in a skilled nursing facility, and 0.3% were in hospital. The expenditure of hospitalizations, primary care, and visits to the emergency department increased few months before the HF.

Conclusions: In patients hospitalized for HF, the expenditure per patient decreases after hospital discharge but the use of healthcare resources is not restored to preinjury values. The increase of expenditures associated with primary care services, hospitalization, and emergency department services during the few months preceding hospital admission suggests a decline of health status in these patients.

Keywords: Hip fractures; dismobility syndrome; health care expenditures; older adults.