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The impact of social isolation on delayed hospital discharges of older hip fracture patients and associated costs

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Abstract

Summary

Delayed discharges represent an inefficient use of acute hospital beds. Social isolation and referral to a public-funded rehabilitation unit were significant predictors of delayed discharges while admission from an institution was a protective factor for older hip fracture patients. Preventing delays could save between 11.2 and 30.7 % of total hospital costs for this patient group.

Introduction

Delayed discharges of older patients from acute care hospitals are a major challenge for administrative, humanitarian, and economic reasons. At the same time, older people are particularly vulnerable to social isolation which has a detrimental effect on their health and well-being with cost implications for health and social care services. The purpose of the present study was to determine the impact and costs of social isolation on delayed hospital discharge.

Methods

A prospective study of 278 consecutive patients aged 75 or older with hip fracture admitted, as an emergency, to the Orthopaedics Department of Hospital Universitário de Santa Maria, Portugal, was conducted. A logistic regression model was used to examine the impact of relevant covariates on delayed discharges, and a negative binomial regression model was used to examine the main drivers of days of delayed discharges. Costs of delayed discharges were estimated using unit costs from national databases.

Results

Mean age at admission was 85.5 years and mean length of stay was 13.1 days per patient. Sixty-two (22.3 %) patients had delayed discharges, resulting in 419 bed days lost (11.5 % of the total length of stay). Being isolated or at a high risk of social isolation, measured with the Lubben social network scale, was significantly associated with delayed discharges (odds ratio (OR) 3.5) as was being referred to a public-funded rehabilitation unit (OR 7.6). These two variables also increased the number of days of delayed discharges (2.6 and 4.9 extra days, respectively, holding all else constant). Patients who were admitted from an institution were less likely to have delayed discharges (OR 0.2) with 5.5 fewer days of delay. Total costs of delayed discharges were between 11.2 and 30.7 % of total costs (€2352 and €9317 per patient with delayed discharge) conditional on whether waiting costs for placement in public-funded rehabilitation unit were included.

Conclusion

High risk of social isolation, social isolation and referral to public-funded rehabilitation units increase delays in patients’ discharges from acute care hospitals.

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Acknowledgments

The authors would like to thank Professor Jacinto Monteiro for allowing the study to be conducted in the Orthopedics Service of Hospital de Santa Maria and for his help and constructive comments. We also wish to thank Dr. Joaquim Soares do Brito, for his helpful collaboration as a participating investigator during the data collection process, and for providing useful comments. We would also like to gratefully acknowledge the help of Ana Maximiano, Renata Gomes, José Miranda and Tânia Fernandes in the gathering of social care data, and Clara Alves and Anabela Matos in identifying patients to take part in the study. Finally, we would like to thank Seamus Kent for discussing this paper at the 2014 joint congress of the International Health Economics Association and European Conference on Health Economics, and to both Seamus Kent and Dr. Wei Han for providing valuable feedback. Filipa Landeiro is sponsored by Fundação para a Ciência e Tecnologia, I.P. (SFRH / BD / 90910 / 2012, financed by POPH-QREN) and Instituto do Envelhecimento – Universidade de Lisboa.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments on comparable ethical standards.

Conflicts of interest

None.

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Authors and Affiliations

  1. Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK

    F. Landeiro, J. Leal & A. M. Gray

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  1. F. Landeiro
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  2. J. Leal
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  3. A. M. Gray
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Correspondence to F. Landeiro.

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Landeiro, F., Leal, J. & Gray, A.M. The impact of social isolation on delayed hospital discharges of older hip fracture patients and associated costs. Osteoporos Int 27, 737–745 (2016). https://doi.org/10.1007/s00198-015-3293-9

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