1. In Hospital Hip Fracture Mortality Colleen McLaughlin, MPH, PhD Division of Quality and Patient Safety

2. Background • STAC request to examine in hospital mortality among hip fracture patients • Is trauma center status associated with risk of in hospital death • Are higher risk patients more likely to be treated at trauma centers • What are the trends in hip fracture inpatient mortality

3. Methods • AHRQ Inpatient Quality Indicator IQI19 Hip Fracture Mortality • National Quality Forum (NQF) Endorsed Measure (NQF #354) • Risk adjusted using All Patient Refined DRG and Risk of Mortality (APR-DRG- ROM) • ROM is based on comorbidities

4. IQI19 Hip fracture mortality definition • Denominator: All discharges, age 65 years and older, with principal diagnosis code for hip fracture (risk set) • Excludes patients with any diagnosis of periprosthetic fracture or who were transferred to another short-term hospital • Numerator: In hospital deaths among risk set

5. Risk adjustment coefficients(national data) APR-DRG risk of mortality 1=minor 2=moderate 3=major 4=extreme

6. Sample Risk of Mortality • Minor: 84 yrs old • Pertrochanteric fracture, closed, Intertrochanteric section; & other wounds • Sinusitis; hypertension; degenerative disc disease • Extreme: 94 yr old • Same fracture • Acute renal failure; Pulmonary collapse; Congestive heart failure; other comorbidities

7. New York Data • SPARCS inpatient discharge data • Stratified analysis • by trauma center, large ED (100+ visits per day), and all other facilities • by facility • Risk factors for mortality based on NY data

8. Statewide Observed Hip Fracture Mortality, 2006-2011

9. Hip Fracture Mortality by ED Type, NYS, 2011 Statewide rate

10. Hip Fracture Mortality by ED Type, NYS, 2010 Statewide rate

11. Hip Fracture Mortality by ED type, 2011

12. Hip Fracture Mortality by ED type, 2010

13. Odds ratios for in hospital death among hip fracture patients, NYS, 2011

14. Odds ratios for in hospital death among hip fracture patients, NYS, 2011

15. Does being treated at a trauma center improve the outcomes for patients with high Risk of Mortality?

16. Percent of Patients seen at Trauma Centers by Risk Adjustment Variables APR-DRG ROM 1=minor 2=moderate 3=major 4=extreme

17. Conclusion • Treatment in a trauma center is generally not associated with statistically significantly improved in hospital mortality risk • Other than those with multiple significant trauma, hip fracture patients are not more likely to be treated in a trauma center compared to patients with other conditions