Impact of prospective payment and discharge location on the outcome of hip fracture

Abstract

Objective:To determine the impact of prospective payment by diagnosis-related groups (DRGs) on length of stay in the hospital, ambulatory status, and level of post-hospital care needed for patients hospitalized with hip fracture. Design:Retrospective chart review of a consecutive series of cases before and after the reference date of implementation of the prospective payment system (PPS). Setting:Academic, tertiary-care hospital. Patients/participants:181 patients 69 years of age or older admitted with International Classification of Diseases (ICD) or DRG codes for hip fracture. Results:Length of stay was shorter by 1.37 days in the post-PPS era (p=0.05). Poorer discharge ambulation was found in the post-PPS group (p=0.089). At one year, differences in ambulation and nursing home residence were found to be related not to the implementation of PPS, but rather to the nursing home to which the patient was discharged. Patients discharged to a facility with active physical rehabilitation were less likely to remain institutionalized (p=0.0025) than those in “ordinary” nursing homes and ambulated more independently (p=0.05). Conclusions:The PPS did not have a significant long-term impact on hip fracture outcome. Post-hospital care may be of crucial importance to the future quality of life of hip fracture patients.