Mortality and locomotion 6 months after hospitalization for hip fracture -Risk factors and risk-adjusted hospital outcomes

Context Hip fracture is a common clinical problem that leads to considerabl e mortality and disability. A need exists for a practical means to monitor and improve outcomes, including function, for patients with hip fracture, Objectives To identify and compare the importance of significant prefractur e predictors of functional status and mortality at 6 months for patients ho spitalized with hip fracture and to compare risk-adjusted outcomes for hosp itals providing initial care. Design Prospective study with data obtained from medical records and throug h structured interviews with patients and proxies. Setting and Participants A total of 571 adults aged 50 years or older with hip fracture who were admitted to 4 New York, NY, metropolitan hospitals be tween August 1997 and August 1998. Main Outcome Measures In-hospital and 6-month mortality; locomotion at 6 mo nths; and adverse outcomes at 6 months, defined as death or needing assista nce to ambulate, compared by hospital, adjusting for patient risk factors. Results The in-hospital mortality rate was 1.6%. At 6 months, the mortality rate was 13.5%, and another 12.8% needed total assistance to ambulate. Lab oratory values were strong predictors of mortality but were not significant ly associated with locomotion. Age and prefracture residence at a nursing h ome were significant predictors of locomotion (P=.02 for both) but were not significantly associated with mortality. Adjustment for baseline character istics either substantially augmented or diminished interhospital differenc es in outcomes. Two hospitals had 1 outcome (functional status or mortality ) that was significantly worse than the overall mean while the other outcom e was nonsignificantly better than average. Conclusions Mortality and functional status ideally should be considered bo th together and individually to distinguish effects limited to one or the o ther outcome. Hospital performance for these 2 measures may differ substant ially after adjustment, probably because different processes of care are im portant to each outcome.