Discharge destination following hip fracture in Canada among previously community-dwelling older adults, 2004–2012: database study
Little is known about post-acute care following hip fracture surgery. We investigated discharge destinations from surgical hospitals for nine Canadian provinces. We identified significant heterogeneity in discharge patterns across provinces suggesting different post-acute recovery pathways. Further work is required to determine the impact on patient outcomes and health system costs.
To examine discharge destinations by provinces in Canada, adjusting for patient, injury, and care characteristics.
We analyzed population-based hospital discharge abstracts from a national administrative database for community-dwelling patients who underwent hip fracture surgery between 2004 and 2012 in Canada. Discharge destination was categorized as rehabilitation, home, acute care, and continuing care. Multinomial logistic regression modeling compared proportions of discharge to rehabilitation, acute care, and continuing care versus home between each province and Ontario. Adjusted risk differences and risk ratios were estimated.
Of 111,952 previously community-dwelling patients aged 65 years or older, 22.5% were discharged to rehabilitation, 31.6% to home, 27.0% to acute care, and 18.2% to continuing care, with significant variation across provinces (p < 0.001). The proportion of discharge to rehabilitation ranged from 2.4% in British Columbia to 41.0% in Ontario while the proportion discharged home ranged from 20.3% in Prince Edward Island to 52.2% in British Columbia. The proportion of discharge to acute care ranged from 15.2% in Ontario to 58.8% in Saskatchewan while the proportion discharged to continuing care ranged from 9.3% in Manitoba and Prince Edward Island to 22.9% in New Brunswick. Adjusting for hospital type changed the direction of the provincial effect on discharge to continuing care in two provinces, but statistical significance remained consistent with the primary analysis.
Discharge destination from the surgical hospital after hip fracture is highly variable across nine Canadian provinces. Further work is required to determine the impact of this heterogeneity on patient outcomes and health system costs.
KeywordsDischarge destination Health services research Hip fracture Variation
LB, BS, PG, JDK, LK, and KJS contributed to the conception and design of the study. SB, PG, LK, and KJS arranged the acquisition of data. JDK and LK conducted the statistical analysis. LB, BS, PG, JDK, LK, KJS, JMS, EH, and SNM contributed to the interpretation of data. LB and JDK drafted the manuscript. LB, BS, PG, JDK, LK, KJS, JMS, EH, and SNM critically revised the manuscript for important intellectual content and approved the final version for submission.
We gratefully acknowledge the guidance from the Canadian Institute for Health Information experts in understanding the discharge abstracts.
This research was funded by the Canadian Institutes of Health Research (MOP 133629). This funder had no role in the design of this study, execution, analyses, data interpretation, or decision to submit results for publication.
The following are members of the Canadian Collaborative Study of Hip Fractures: Lauren Beaupre, Eric Bohm, Michael Dunbar, Donald Griesdale, Pierre Guy, Edward Harvey, Erik Hellsten, Susan Jaglal, Hans Kreder, Lisa Kuramoto, Adrian Levy, Suzanne N. Morin, Katie J. Sheehan, Boris Sobolev, Jason M. Sutherland, and James Waddell.
Compliance with ethical standards
Conflicts of interest
The following competing interests are declared: (1) LB is the David Magee Endowed Chair in Musculoskeletal Research supported by the Faculty of Rehabilitation Medicine at the University of Alberta. (2) PG has received grants from the Canadian Institutes of Health Research related to this work. PG also receives funding from the Natural Sciences and Engineering Research Council of Canada, the Canadian Foundation for Innovation, and the British Columbia Specialists Services Committee for work around hip fracture care not related to this manuscript. He has also received fees from the BC Specialists Services Committee (for a provincial quality improvement project on redesign of hip fracture care) and from Stryker Orthopedics (as a product development consultant). He is a board member and shareholder in Traumis Surgical Systems Inc. and a board member for the Canadian Orthopedic Foundation. He also serves on the speakers’ bureaus of AO Trauma North America and Stryker Canada. (3) SNM reports research grants from Amgen Canada and from Merck. (4) BS, JDK, LK, KJS, JMS, and EH declare they have no conflicts of interest.
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