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Outcomes and Costs of Post-Acute Care Pathways in Hip Fracture Patients: Implications of Trade-Offs in Resource Allocation
| Content Provider | Semantic Scholar |
|---|---|
| Author | Pitzul, Kristen B. |
| Copyright Year | 2017 |
| Abstract | There is a gap in evidence with respect to the delivery of quality post-acute care for hip fracture patients. The primary objective of this thesis is to describe the post-acute care pathways of hip fracture patients and their associated outcomes (i.e., mortality and rehospitalizations) and health system costs. The secondary objective is to explore the use of system dynamics modelling to determine the impact of trade-offs in resource allocation on patient outcomes and health system costs. Population-level administrative databases were used to capture older adults admitted to acute care for hip fracture between 2008 and 2012 in Ontario, Canada. Study one describes the variation in post-acute care pathways for hip fracture patients and concluded that four health regions discharge a relatively higher proportion of patients to inpatient rehabilitation (IPR) compared to the remaining 10 health regions. In study two, patients discharged directly from acute care to the community (i.e., community patients) were matched to patients discharged directly from acute care to IPR (i.e., IPR patients). A substantially higher proportion of community patients died or reiii hospitalized and had substantially lower health system costs compared to their matched IPR counterparts. Results of study three suggest that only 60% of community patients receive post-acute rehabilitation, and of the community patients who do receive it, they have substantially lower rehabilitation intensity and specialists’ visits compared to their matched IPR counterparts, regardless of health region. Study four’s system dynamics model predicts the increased health system costs required to increase the number of hours of home-based rehabilitation to attenuate these differences in re-hospitalizations. Taken together, results suggest that the variations in hip fracture post-acute delivery are pervasive in Ontario and that the impact of this variation on patient outcome may be attenuated through increased allocation of resources to home-based rehabilitation. Results can be used by policymakers, clinicians, and researchers to further improve and understand the post-acute quality of care delivered to hip fracture patients. |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://tspace.library.utoronto.ca/bitstream/1807/79418/3/Pitzul_Kristen_B_201706_PhD_thesis.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
