Hip Fracture Setting Priorities for Effectiveness Research (1990) / Chapter Skim
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KEY PATIENT MANAGEMENT TOPICS FOR EFFECTIVENESS RESEARCH IN HIP FRACTURE
KEY PATIENT MANAGEMENT TOPICS FOR EFFECTIVENESS RESEARCH IN HIP FRACTURE
Pages 25-40
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From page 25... ...
In addition, prevention and management of secondary complications of hip fractures were noted by a few committee members as patient management topics suitable for effectiveness research. Issues of cost, cost-effectiveness, and cost-efficiency were noted with some frequency across all categories.
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METHODS ISSUES Health and Functional Status Assessment Recent work in measuring health status and functional capabilities is quite extensive. There is little consensus, however, as to formats that should be adopted by a government agency or by private researchers to measure iAll four methodologic issues noted in this report pertain as well to breast cancer and acute myocardial infarction research strategies, and they are discussed in the companion reports with modifications pertinent to the diseases under consideration.
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From page 27... ...
~ move forward in effectiveness research, the recent work on health and functional status assessment must be synthesized; the committee cautioned against "reinventing the wheel" in this area. The use of "generic" health status measures (e.g., the Sickness Impact Profile, the Visual Analogue Pain rating scales, or the Index of Independence in Activities of Daily Living)
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From page 28... ...
~ A ~ It was beyond the charge of this committee to specify components of a geriatric health and functional status assessment instrument suitable for hip fracture research. In general, however, the committee believed that this assessment instrument should include components of what has classically been called functional capabilities (including Activities of Daily Living [AD Ls]
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From page 29... ...
The committee wishes to emphasize that for hip fracture (more than for breast cancer or acute myocardial infarction) , health and functional status assessment before the adverse clinical event is necessary to interpret these and other outcome measures appropriately.
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Research currently being conducted on hip fracture outcomes by investigators at the University of Minnesota School of Public Health was identified as an example of a follow-up study that will yield health and functional status information across various settings. In that study, prehospital functioning was assessed retrospectively; functional status was measured at the time of discharge and at two weeks, six weeks, six months, and one year after discharge.
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From page 31... ...
the patient population into various classes resecting their baseline functional status. If four or five different classes of patients were identified, more realistic outcome goals for each class of patient could be developed.
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PATIENT MANAGEMENT ISSUES Prevention Prevention of hip fracture was identified as a priority patient management issue because of the high social costs and grim personal consequences for elderly victims in terms of pain, disability, functional limitations, and displacement from community living. Prevention is a very promising area of study.
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From page 33... ...
As noted earlier, approximately 260,000 hip fractures occur among the elderly each year, with an associated medical cost estimated at over $6 billion, and falls are clearly a major factor in this picture.5 The committee recommends that effectiveness research efforts address pathophysiologic processes, the primary aging processes, and behavioral and environmental factors associated with falls. Outcomes and the cost-effectiveness of various prevention strategies must be evaluated.
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From page 34... ...
The committee noted, however, that the absence of outpatient medication information will limit effectiveness research that otherwise might be conducted using the Medicare insurance claims files. That is, HCFA databases currently offer little assistance in this area because Medicare does not cover outpatient prescription drugs.
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~ These factors for predicting selection of nonsurgical treatment options are based on preliminary results of a study being conducted by investigator at Lee RAND Corporation. Approximately 2,800 patients with hip fractures were selected from the Medicare files and their medical records were abstracted to obtain information to clarify treatment selection factors.
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From page 36... ...
Cone need for a minimal data set shared by all effectiveness research is implicit throughout these recommendations. The appendix contains additional information on the Uniform Clinical Data Set.
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The committee recommends that HCFA concentrate its effectiveness research for rehabilitation on four areas: (1) minimal data set, (2)
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Timing and Intensity Issues in Rehabilitation Medicare currently covers 100 days of rehabilitation services and nursing home care when a potential for improvement can be demonstrated. Electiveness research could help define appropriate services and time frames for benefits that are effective in terms of both health status and cost.
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From page 39... ...
Hypothesis Generation The possibility that the HCFA databases can be used to generate hypotheses should not be overlooked. Often, a hip fracture signals a rapid decline in health status and functional capabilities.
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