Hip fracture patients recover better in high-occupancy nursing homes with higher level physician staffing

Quality of post-acute care that older adults hospitalised with hip fracture receive has a greater impact on long-term recovery than the care they receive at the hospital, says new research in Medical Care.

Experts in the US compared outcome variations in acute and post-acute care experienced by more than 42,000 Medicare patients aged over 80 years old.

Impact of post-acute care (care received in nursing homes, rehabilitation facilities, at-home, etc) on outcomes, including mortality and mobility, was three to eight times greater than the impact of hospital factors.

Patient characteristics represented the main determinants of outcomes after hip fractures. But selected hospital and nursing home characteristics were associated with short-and long-term outcomes.

Hospital characteristics – nurse-to-bed ratio, average hospital nurse skill mix, and hospital for-profit status, for example – were not consistently associated with outcomes. But multiple nursing home characteristics – bed count, chain membership, and performance on selected quality measures – did predict outcomes.

Key findings

• Patients treated at a nursing home with low occupancy, more than 150 beds versus a facility with less than 100 beds, and with historically high mortality rates, were more likely to die or have a new inability to walk after 30 days;
• A higher number of nursing homes in a specific region – and ownership by a multi-facility organisation were modestly associated with 30-day mortality;
• Facilities that used more full-time physician assistants and nurse practitioners – and those with a full-time director of nursing were modestly associated with 180-day mortality;
• Nursing homes located within a hospital were associated with 180-day mortality.

“These results highlight the major impact that post-acute care has on basic outcomes such as survival and walking ability among this patient population,” says the study’s lead author Dr Mark D. Neuman.“For patients, it sends the simple message that post-acute care, for instance, at a nursing home, may have a major impact on recovery in the long term.”

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