gms | German Medical Science

17. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

10. - 12.10.2018, Berlin

Patient and regional characteristics as sources of variation in care dependence after femoral fracture

Meeting Abstract

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  • Claudia Schulz - Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung, Hamburg
  • Katrin Reber - Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung, Hamburg
  • Hans-Helmut König - Universitätsklinikum Hamburg-Eppendorf, Institut für Gesundheitsökonomie und Versorgungsforschung, Hamburg

17. Deutscher Kongress für Versorgungsforschung (DKVF). Berlin, 10.-12.10.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. Doc18dkvf003

doi: 10.3205/18dkvf003, urn:nbn:de:0183-18dkvf0034

Veröffentlicht: 12. Oktober 2018

© 2018 Schulz et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Femoral fractures are common consequences of falls in the elderly. They are associated with considerable costs and lead to negative health outcomes such as reduced quality of life and increased functional impairment. Femoral fractures may result in care dependence in the long run, causing an enormous burden for patients, their families and society. Until 2016 the German long-term care insurance classified care recipients according to a standardized classification system consisting of 3 care levels. It was based on required assistance in performing activities of daily living and assessed by a qualified physician or nurse. Thus, care level reflects the degree of care dependence which might be affected by patient characteristics as well as regional factors. Analysis of the latter might reveal inequalities and health gaps across regions.

Therefore, the aim of this study was to determine relevant patient characteristics and regional factors which are related to the likelihood of an increasing care dependence in terms of worsening care level after femoral fracture.

We used patient-level statutory health insurance claims data from 2009 through 2011. Additional information was obtained from the list of German hospitals (“Krankenhausverzeichnis”), the statistical office of the European Union (Eurostat) and the Regional Database, provided by the German Federal Statistical Office. We incorporated the hierarchical structure of the data by applying a generalized linear mixed model. The association of independent variables both on patient and regional level with worsening care level in the quarterly period after femoral fracture was investigated. Death constitutes a competing risk and was modeled as additional nominal outcome.

The dataset contained information on 122,922 femoral fracture patients in 1,522 hospitals in 38 German regions. Among all patients, crude rates were 30.87% for worsening care level, 52.78% for unchanged care level and 14.35% for death after femoral fracture. The multivariate analysis revealed that the patient factors male sex, increasing age, increasing comorbidity and an average length of inpatient treatment were significantly (p < .0001) associated with a worsening care level. However, we observed only a slight variation of worsening care level across regions, which could not be sufficiently explained by regional factors.

An increasing care dependence in terms of worsening care level after femoral fracture is related to various patient characteristics. However, we cannot provide evidence on differing care dependence of femoral fracture patients between German regions. Analysis suggested a higher extent of variation on patient than on regional level.

The lack of regional variation of patients’ care dependence after femoral fracture might suggest a highly standardized and in all region similar health care and treatment of femoral fractures in Germany. The identification of patient-related risk factors may help to forecast care dependence after femoral fracture. Efforts should be directed to identify further risk factors for care dependence and to explore the causality of these results.