(Taken from the application): There have been enormous changes in the care of hip fracture patients in recent years, including improved surgical techniques, earlier surgical repair, and earlier postoperative weight bearing. Since the advent of prospective payment to hospitals, the length of hospital stay for hip fracture has decreased dramatically and there has been a large increase in the variety of postacute care settings to which patients are discharged. Yet, nothing is known about the impact of these changes in locus of care on patient outcomes. Our goal is to study one such outcome (pressure ulcers) among elderly hip surgery patients in the current health care environment.
The specific aims of this study are to estimate the incidence of pressure ulcers among elderly patients who have undergone surgical repair for hip fracture; to compare care settings (e.g., acute care hospital, onsite subacute unit, rehabilitation facility, nursing home, home) with respect to the incidence of pressure ulcers and with respect to use of pressure ulcer prevention measures; to assess the relationship between the incidence of pressure ulcers and certain characteristics of the early postfracture period (e.g., length of time waiting before transport to hospital; length of stay in the Emergency Department); and to develop a predictive model relating patient characteristics and characteristics of the postfracture period to individual patients risk of pressure ulcers. To achieve the research aims, a prospective cohort study will be carried out in eight hospitals that are part of the Baltimore Hip Studies network. The cohort will be made up of 1,240 eligible, consenting patients aged 60 years or more who undergo surgical repair of hip fracture. All patients will undergo a full-body skin inspection on admission and on alternating postoperative days, up to the 21 St postoperative day. If the patient is discharged home or to a postacute setting in the course of the follow-up period, the skin exam will be performed in the new setting. Additional data will be obtained by interview and chart review. The incidence of pressure ulcers per person-day of follow-up will be estimated overall and separately for each type of care setting. Discrete time proportional hazards models will be used to identify risk factors that are associated with increased pressure ulcer rates and to develop a statistical model for predicting patients individual risks. Pressure ulcers represent a significant problem both in terms of patient suffering and cost of care. By identifying settings, characteristics of the postfracture period, and patient characteristics that are associated with especially high risk, the proposed study will provide information for clinical practice, health care planning, and the development of future clinical trials.
