Comprehensive Access & Delivery Research and Evaluation Center, Iowa City VA Healthcare System, Mailstop 152, 601 Highway West, Iowa City, IA 52246, USA.
Clin Orthop Relat Res. 2013 Mar;471(3):1047-53. doi: 10.1007/s11999-013-2783-3. Epub 2013 Jan 16.
Hip fracture is a medical emergency for which delayed treatment increases risk of disability and death. In emergencies, veterans without access to a Veterans Administration (VA) hospital may be admitted to non-VA hospitals under fee-based (NVA-FB) care paid by the VA. The affect of NVA-FB care for treatment and outcomes of hip fractures is unknown.
QUESTIONS/PURPOSES: This research seeks to answer three questions: (1) What patient characteristics determine use of VA versus NVA-FB hospitals for hip fracture? (2) Does time between admission and surgery differ by hospital (VA versus NVA-FB)? (3) Does mortality differ by hospital?
Veterans admitted for hip fractures to VA (n = 9308) and NVA-FB (n = 1881) hospitals from 2003 to 2008 were identified. Primary outcomes were time to surgery and death. Logistic regression identified patient characteristics associated with NVA-FB hospital admissions; differences in time to surgery and death were evaluated using Cox proportional hazards regression, controlling for patient covariates.
Patients admitted to NVA-FB hospitals were more likely to be younger, have service-connected disabilities, and live more than 50 miles from a VA hospital. Median days to surgery were less for NVA-FB admissions compared with VA admissions (1 versus 3 days, respectively). NVA-FB admissions were associated with 21% lower relative risk of death within 1 year compared with VA hospital admissions.
For veterans with hip fractures, NVA-FB hospital admission was associated with shorter time to surgery and lower 1-year mortality. These findings suggest fee-based care, especially for veterans living greater distances from VA hospitals, may improve access to care and health outcomes.
Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
髋部骨折是一种医疗急症，延迟治疗会增加残疾和死亡的风险。在紧急情况下，无法前往退伍军人事务部 (VA) 医院的退伍军人可能会根据退伍军人事务部的收费基础 (NVA-FB) 护理标准被送往非退伍军人事务部医院接受治疗。目前尚不清楚 NVA-FB 护理对髋部骨折的治疗和结果的影响。
问题/目的：本研究旨在回答三个问题：(1) 哪些患者特征决定了髋部骨折患者选择 VA 医院与 NVA-FB 医院？(2) 入院与手术之间的时间间隔是否因医院（VA 与 NVA-FB）而异？(3) 死亡率是否因医院而异？
从 2003 年至 2008 年，确定了在 VA（n = 9308）和 NVA-FB（n = 1881）医院因髋部骨折入院的退伍军人。主要结局是手术时间和死亡时间。逻辑回归确定了与 NVA-FB 医院入院相关的患者特征；使用 Cox 比例风险回归评估手术时间和死亡时间的差异，同时控制患者协变量。
NVA-FB 医院入院的患者更年轻、有与服务相关的残疾，且距离 VA 医院超过 50 英里。与 VA 入院相比，NVA-FB 入院的患者接受手术的中位数时间更短（分别为 1 天和 3 天）。与 VA 医院入院相比，NVA-FB 入院在 1 年内死亡的相对风险降低了 21%。
对于髋部骨折的退伍军人，NVA-FB 医院入院与手术时间更短和 1 年死亡率降低相关。这些发现表明，收费基础护理，特别是对于距离 VA 医院较远的退伍军人，可能会改善获得护理和健康结果的机会。
二级，预后研究。有关证据水平的完整描述，请参阅作者指南。
