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Facility and State Variation in Hip Fracture in U.S. Nursing Home Residents
Author(s) -
Zullo Andrew R.,
Zhang Tingting,
Banerjee Geetanjoli,
Lee Yoojin,
McConeghy Kevin W.,
Kiel Douglas P.,
Daiello Lori A.,
Mor Vincent,
Berry Sarah D.
Publication year - 2018
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15264
Subject(s) - medicine , hip fracture , staffing , incidence (geometry) , confidence interval , acute care , minimum data set , nursing homes , skilled nursing facility , retrospective cohort study , emergency medicine , demography , health care , nursing , osteoporosis , physics , sociology , optics , economics , economic growth
Objectives To quantify the variation in hip fracture incidence across U.S. nursing home ( NH ) facilities and states and examine how hip fracture incidence varies according to facility‐ and state‐level characteristics. Design Retrospective cohort using linked national Minimum Data Set assessments; Online Survey, Certification and Reporting records; and Medicare claims. Setting U.S. NH s with 100 or more beds. Participants Long‐stay NH residents between May 1, 2007, and April 30, 2008, from 1,481 facilities and 46 U.S. states (N = 201,892). Measurements Incident hip fractures were ascertained using Medicare Part A diagnostic codes. Each resident was followed for up to 2 years. Results The mean adjusted incidence rate of hip fractures for all facilities was 3.13 (95% confidence interval ( CI ) = 3.01–3.26) per 100 person‐years (range 1.20, 95% CI = 1.15–1.26 to 6.40, 95% CI = 6.07–6.77). Facilities with the highest rates of hip fracture had greater percentages of residents taking psychoactive medications (top tertile 27.2%, bottom tertile 24.8%), and fewer nursing (top tertile 3.43, bottom tertile 3.53) and direct care (top tertile 3.22, bottom tertile 3.29) hours per day per resident. The combination of state and facility characteristics explained 6.7% of the variation in hip fracture, and resident characteristics explained 7.6%. Conclusion Much of the variation in hip fracture incidence remained unexplained, although these findings indicate that potentially modifiable state and facility characteristics such as psychoactive drug prescribing and minimum staffing requirements could be addressed to help reduce the rate of hip fracture in U.S. NH s.