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Functional outcomes may be good markers of quality of care for hip fracture surgery patients

Functional outcomes among hip fracture surgery patients could indicate important differences in the processes of care related to improved patient functioning, suggests a new study. Researchers found that functional outcomes of patients who underwent surgery for hip fracture were more sensitive markers of improved process of care than 6-month mortality rates. Improving functional outcomes is critical, since only 60 percent of surviving older hip fracture patients eventually return to their prefracture level of walking.

It is important to attend to all steps in the care of hip fracture patients. For example, the benefit from early surgery may be short-lived if it is not followed up by timely mobilization, early initiation of rehabilitation, and attention to postoperative care. Researchers examined the relationship between functional outcome and 9 processes of care related to mobilization for 554 patients who underwent surgery for hip fracture at 4 hospitals. They used information from medical records, interviews, and bedside observations. They also used the Functional Independence Measure (FIM), survival, and hospital readmission to assess patient outcomes 6 months later.

The nine-item mobility process of care measure was associated with improved locomotion, self-care, and transferring (for example, from bed to chair) at 2 months. The predicted value for the FIM locomotion measure (range 2-14) at 2 months was 5.9 for patients at the 10th percentile of performance on these care processes compared with 7.1 at the 90th percentile. However, the benefits were smaller and not significant by 6 months. These care processes were not associated with mortality. Individual processes of care were generally not associated with outcomes, which suggests that any single process may be dependent on other care processes. The study was supported in part by the Agency for Healthcare Research and Quality (HS09459 and HS09973).

See "Effect of inpatient quality of care on functional outcomes in patients with hip fracture," by Albert L. Siu, M.D., M.S.P.H., Kenneth S. Boockvar, M.D., M.S., Joan D. Penrod, Ph.D., and others, in the September 2006 Medical Care 44(9), pp. 862-869.

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