Letter to the Editor: Fee-based Care is Important for Access to Prompt Treatment of Hip Fractures Among Veterans
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- Cite this article as:
- Bernstein, J. Clin Orthop Relat Res (2013) 471: 2036. doi:10.1007/s11999-013-2952-4
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To the Editor:
As an orthopaedic surgeon who fixes hip fractures at a VA hospital, I was proud to read the study by Richardson et al., Fee-based Care is Important for Access to Prompt Treatment of Hip Fractures Among Veterans , showing that non-VA hospitals have a 21% lower 1-year mortality for patients with hip fractures.
One may wonder why I would be proud to read a study that ostensibly shows a better performance at a Non-VA hospital. Truth be told, I was proud only when I looked closely at their data.
The mean age of VA patients in their study was 76 years, versus 71 years for the non-VA group.
It probably is no surprise to discover that a 76-year-old person is more likely to die than a 71-year-old—in fact, the 1-year mortality rate, 4.4%, is 57% higher that of a 71-year-old person, 2.8% . As such, finding that the rates differed by only 21% show that the VA is associated with a distinctly reduced rate of mortality, when the base case risk is considered.
I point this out not to be a schoolmarm or to shill for my friend, Howard Wainer, whose book, coauthored with Lawrence Hubert), A Statistical Guide for the Ethically Perplexed , teaches this point. I point this out particularly because in the coming years, the debate about healthcare reform no doubt will put the VA system under heightened scrutiny, as the VA does things differently compared with civilian institutions. When the VA does something better—technically speaking, “is associated with something better” for association does not imply causality—it should be celebrated.