An international comparison of long‐term care trajectories and spending following hip fracture

Wodchis, Walter P.; Or, Zeynep; Blankart, Carl Rudolf; Atsma, Femke; Janlov, Nils; Bai, Yu Qing; Penneau, Anne; Arvin, Mina; Knight, Hannah; Riley, Kristen; Figueroa, Jose F.; Papanicolas, Irene (2021). An international comparison of long‐term care trajectories and spending following hip fracture. Health Services Research, 56 Suppl 3(Suppl 3), pp. 1383-1393. Wiley 10.1111/1475-6773.13864

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Objective
The objectives of this study are to compare the relative use of different postacute care settings in different countries and to compare three important outcomes as follows: total expenditure, total days of care in different care settings, and overall longevity over a 1-year period following a hip fracture.

Data Sources
We used administrative data from hospitals, institutional and home-based long-term care (LTC), physician visits, and medications compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) from five countries as follows: Canada, France, Germany, the Netherlands, and Sweden.

Data Extraction Methods
Data were extracted from existing administrative data systems in each participating country.

Study Design
This is a retrospective cohort study of all individuals admitted to acute care for hip fracture. Descriptive comparisons were used to examine aggregate institutional and home-based postacute care. Care trajectories were created to track sequential care settings after acute-care discharge through institutional and community-based care in three countries where detailed information allowed. Comparisons in patient characteristics, utilization, and costs were made across these trajectories and countries.

Principal Findings
Across five countries with complete LTC data, we found notable variations with Germany having the highest days of home-based services with relatively low costs, while Sweden incurred the highest overall expenditures. Comparisons of trajectories found that France had the highest use of inpatient rehabilitation. Germany was most likely to discharge hip fracture patients to home. Over 365 days, France averaged the highest number of days in institution with 104, Canada followed at 94, and Germany had just 87 days of institutional care on average.

Conclusion
In this comparison of LTC services following a hip fracture, we found international differences in total use of institutional and noninstitutional care, longevity, and total expenditures. There exist opportunities to organize postacute care differently to maximize independence and mitigate costs.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Faculty Institutions > sitem Center for Translational Medicine and Biomedical Entrepreneurship > Healthcare Regulation and Management
11 Centers of Competence > KPM Center for Public Management

UniBE Contributor:

Blankart, Rudolf

Subjects:

300 Social sciences, sociology & anthropology > 350 Public administration & military science

ISSN:

0017-9124

Publisher:

Wiley

Funders:

[UNSPECIFIED] The Commonwealth Fund, NY, USA ; [UNSPECIFIED] The Health Foundation, UK

Language:

English

Submitter:

Carl Rudolf Berchtold Blankart

Date Deposited:

04 Oct 2021 13:33

Last Modified:

02 Mar 2023 23:35

Publisher DOI:

10.1111/1475-6773.13864

PubMed ID:

34378190

BORIS DOI:

10.48350/159468

URI:

https://boris.unibe.ch/id/eprint/159468

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