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Osteoporosis International
Published in: Osteoporosis International 7/2019

01-07-2019 | Care | Original Article

Discharge destination following hip fracture in Canada among previously community-dwelling older adults, 2004–2012: database study

Authors: L. Beaupre, B. Sobolev, P. Guy, J. D. Kim, L. Kuramoto, K. J. Sheehan, J. M. Sutherland, E. Harvey, S. N. Morin, for The Canadian Collaborative Study of Hip Fractures

Published in: Osteoporosis International | Issue 7/2019

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Abstract

Summary

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.

Introduction

To examine discharge destinations by provinces in Canada, adjusting for patient, injury, and care characteristics.

Methods

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.

Results

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.

Conclusions

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.
Appendix
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Metadata
Title
Discharge destination following hip fracture in Canada among previously community-dwelling older adults, 2004–2012: database study
Authors
L. Beaupre
B. Sobolev
P. Guy
J. D. Kim
L. Kuramoto
K. J. Sheehan
J. M. Sutherland
E. Harvey
S. N. Morin
for The Canadian Collaborative Study of Hip Fractures
Publication date
01-07-2019
Publisher
Springer London
Keyword
Care
Published in
Osteoporosis International / Issue 7/2019
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-019-04943-6

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