Table 1.
Characteristics of Community-Dwelling Individuals with First-Time Hip Fracture Living in a Skilled Nursing Facility (SNF), 2000–2007, and Characteristics of SNFs According to Annual SNF Provider Volume of Hip Fracture Admissions (N = 15,439 SNFs)
| Annual Volume of Hip Fracture Admissions a |
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|---|---|---|---|---|---|
| Characteristic | 0–6, n = 120,465 (23.5%) |
7–13, n = 130,914 (25.5%) |
14–24, n = 128,456 (25.1%) |
≥25, n = 133,132 (25.9%) |
Total, N = 512,967 |
| Successful discharge to community, % | 18.8 | 24.9 | 34.3 | 43.7 | 30.8 |
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| Censored (died within 60 days of discharge from hospital), % |
9.0 | 8.3 | 7.0 | 6.1 | 7.6 |
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| Participant characteristics b | |||||
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| Age, mean ± SD | 85.5 ± 5.7 | 85.3 ± 5.7 | 85.0 ± 5.6 | 84.7 ± 5.6 | 85.1 ± 5.7 |
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| Female, % | 78.1 | 78.9 | 78.7 | 78.7 | 78.6 |
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| Race, % | |||||
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| White | 92.5 | 94.9 | 95.2 | 95.7 | 94.6 |
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| Black | 4.4 | 2.7 | 2.5 | 2.1 | 2.9 |
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| Hispanic | 1.1 | 0.8 | 0.9 | 0.8 | 0.9 |
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| Otherc | 1.6 | 1.2 | 1.1 | 1.1 | 1.2 |
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| Marital status, % | |||||
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| Never married | 6.2 | 5.6 | 5.2 | 5.0 | 5.5 |
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| Currently married | 25.1 | 26.1 | 28.0 | 30.0 | 27.4 |
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| Widowed, divorced | 68.7 | 68.3 | 66.8 | 65.0 | 67.1 |
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| Femoral neck fracture, % | 47.5 | 48.1 | 2.4 ± 1.3 | 2.4 ± 1.3 | 48.6 |
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| Number of Elixhauser comorbidities, mean ± SD | 2.4 ± 1.3 | 2.4 ± 1.3 | 2.4 ± 1.3 | 2.4 ± 1.3 | 2.4 ± 1.3 |
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| Hospital length of stay, days, mean ± SD | 6.9 ± 4.4 | 6.6 ± 4.0 | 6.3 ± 3.8 | 6.3 ± 3.7 | 6.5 ± 4.0 |
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| Body mass index, kg/m2, mean±SD | 23.6 ± 4.9 | 23.7 ± 4.8 | 23.8 ± 4.7 | 23.8 ± 4.7 | 23.7 ± 4.8 |
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| Activity of daily living score (range 0–28), mean ± SD | 19.0 ± 4.7 | 18.5 ± 4.5 | 17.8 ± 4.5 | 17.2 ± 4.3 | 18.1 ± 4.5 |
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| Comorbidities, % | |||||
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| Osteoporosis | 17.6 | 18.4 | 17.0 | 15.1 | 17.0 |
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| Congestive heart failure | 16.4 | 16.0 | 14.7 | 13.4 | 15.1 |
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| Cardiovascular disease | 15.0 | 14.8 | 13.3 | 12.1 | 13.8 |
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| Cerebrovascular accident | 9.5 | 8.9 | 7.7 | 6.8 | 8.2 |
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| Diabetes mellitus | 18.1 | 17.9 | 17.4 | 16.8 | 17.5 |
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| Depression | 20.5 | 20.9 | 19.2 | 17.4 | 19.5 |
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| Cognitive Performance Scale score, mean ± SD (range 0–6) |
1.9 ± 1.7 | 1.7 ± 1.6 | 1.5 ± 1.6 | 1.3 ± 1.5 | 1.6 ± 1.6 |
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| Alzheimer’s disease or dementia, % | 25.1 | 22.7 | 18.2 | 13.6 | 19.8 |
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| Bladder or bowel incontinence, % | 25.1 | 21.5 | 17.9 | 14.6 | 19.7 |
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| Lived alone, % | 36.0 | 36.7 | 37.8 | 39.5 | 37.5 |
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| Do-not-resuscitate order, % | 37.7 | 33.5 | 26.2 | 17.8 | 28.6 |
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| Hospital hip fracture volume, mean ± SD | 76.3 ± 52.9 | 79.6 ± 54.3 | 82.3 ± 53.7 | 99.6 ± 53.5 | 84.7 ± 54.4 |
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| SNF characteristicsd | |||||
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| Based in a hospital, % | 6.6 | 12.5 | 26.7 | 42.9 | 22.5 |
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| Not for profit, % | 27.6 | 32.3 | 40.1 | 51.3 | 38.1 |
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| Multisite (part of a chain), % | 59.4 | 58.0 | 53.7 | 46.0 | 54.1 |
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| Number of beds, mean ± SD | 104.2 ± 55.2 | 119.0 ± 67.0 | 117.2 ± 83.9 | 122.3 ± 108.3 | 115.9 ± 81.9 |
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| Dedicated rehabilitation unit, % | 2.1 | 4.2 | 6.6 | 9.4 | 5.6 |
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| FTE registered nurses per 10 residents | 0.9 | 1.2 | 1.8 | 2.5 | 1.6 |
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| FTE licensed practical nurses per 10 residents | 1.7 | 1.8 | 2.0 | 2.2 | 1.9 |
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| FTE PTs per 10 residents receiving therapy | 1.9 | 1.8 | 2.0 | 2.5 | 2.0 |
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| ≥80% of FTE PTs on staff (not contracted), % | 41.1 | 54.1 | 65.0 | 74.0 | 59.1 |
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| FTE occupational therapists per 10 residents receiving therapy |
1.5 | 1.4 | 1.5 | 1.7 | 1.5 |
SD = standard deviation; FTE = Full-time equivalent; PT = physical therapist.
Volume in the 12 months before participant’s discharge from the hospital for hip fracture.
Participant characteristics included in the models but not reported in Table 1 included postoperative pulmonary failure, pulmonary embolism, postoperative acute renal failure, time to surgery from hospital admission, intensive care unit use, hypertension, hypotension, arteriosclerotic heart disease, cardiac dysrhythmias, peripheral vascular disease, arthritis, hemiplegia or hemiparesis, multiple sclerosis, paraplegia, Parkinson’s disease, seizure disorder, transient ischemic attack, traumatic brain injury, anxiety disorder, bipolar, schizophrenia, asthma, anemia, cancer, renal insufficiency, clostridium difficile, antibiotic resistant infection, septicemia, pressure ulcers, urinary tract infection, daily pain, and problem swallowing.
Race was unknown for 0.4% of participants, so race percentages do not add up to 100%.
SNF characteristics also included facility average resource utilization group case-mix classification index, calculated from all admissions (mostly SNF residents) in a given year and from all residents on a given day (to account for severity of non-SNF residents) to adjust the facility staffing levels for facility resident severity.39