Hip Fracture Study Calls for Assessing Patients' Risks

EMBARGOED FOR RELEASE Tuesday, June 5, 2001 4:00 p.m. EDT

Contact: AHRQ Public Affairs, (301)594-1364Karen Migdail, (301)594-6120, [email protected]

HIP FRACTURE STUDY CALLS FOR ASSESSING PATIENTS' RISKS OF BOTH FUNCTIONAL IMPAIRMENT AND DEATH

A new study sponsored by the U.S. Agency for Healthcare Research and Quality (AHRQ) could help acute and post-acute care medical staff improve the outcomes of the approximately 350,000 hip fractures that occur annually in the United States by focusing efforts on reducing the risks that often leave patients unable to walk or lead to death from complications.

Currently, four of every 10 patients are unable to walk without total assistance by six months after the fracture occurs and a quarter of patients die within a year. In addition to its human toll, hip fracture and its consequences have a large economic impact, with hospital charges alone totaling roughly $6 billion a year. The challenge has been to identify characteristics that put patients at higher risk for these adverse outcomes.

The study's analysis of data on hip fracture patients in four New York City hospitals between August 1997 and August 1998 found that when patients required moderate to total assistance for walking or stair climbing prior to admission, there was a higher likelihood of poor post-fracture functional ability. Limited pre-fracture locomotion combined with the presence of chronic medical conditions were risk factors that made death more likely.

Of the 571 elderly patients studied, nearly 2 percent died in the hospitals and roughly equal percentages -- about 13 percent -- either died within six months or needed total assistance to walk or use a wheel chair.

The researchers, who were led by Albert L. Siu, M.D., of Mount Sinai School of Medicine, identified risk factors that accurately predicted the loss of locomotion and/or death. While previous studies have identified patient factors related to either the recovery of hip fracture patients or to death, most looked at function or mortality independently, and none reported on how risk-adjusted outcomes could be obtained to assess the effectiveness or quality of care in a hospital or post-acute care setting.

AHRQ's director, John M. Eisenberg, M.D., said, "Hip fracture care is increasingly fragmented among acute care providers, and those in rehabilitation units, nursing homes and home health agencies. The message of this study is that all providers, regardless of where they work, should assess these risks of disability and death, and take action to prevent adverse outcomes in patients with hip fracture."

Hip fracture patients, most of whom are elderly, are first admitted to acute care hospitals where rehabilitative services generally exist to improve functional mobility and where there are nursing services for preventing or treating common postoperative complications, such as thrombophlebitis, surgical site infection and delirium. Following discharge, the typical hip fracture patient receives post-acute rehabilitative services in a skilled nursing facility, acute rehabilitative unit, home health program or a combination of these.

Dr. Siu, a professor of medicine at Mount Sinai, said, "Currently, each group involved in the care of a hip fracture patient views only their small section of the overall condition. This means that aspects of care that need to be followed often slip through the cracks." Dr. Siu added that "close scrutiny and observation is critical to developing effective means of managing the care of hip fracture patients."

Details are in "Mortality and Locomotion Six Months After Hospitalization for Hip Fracture: Risk Factors and Risk-Adjusted Hospital Outcomes," in the June 6, 2001 issue of the Journal of the American Medical Association.

Note to Editors: For interviews of Dr. Siu, please contact Deborah Kaplan at the Mount Sinai School of Medicine Public Affairs Office, (212)659-9045.