Exposing the Care Conundrum of Low-Energy Pelvic Ring Fractures in Older Adults: A Review of 322 Patients

Introduction A care conundrum for low-energy pelvic ring fracture patients in which they face financial burden after not qualifying for an inpatient stay of 3 days or more has been noted in the literature. The purpose of this study was to identify factors that lead to inpatient length of stay (IP LO...

Full description

Saved in:
Bibliographic Details
Published in:Geriatric orthopaedic surgery & rehabilitation 2023-11, Vol.14, p.21514593231216390-21514593231216390
Main Authors: Abernathy, Bailey R., Huyke-Hernández, Fernando A., Rivard, Rachael L., Schroder, Lisa K., Switzer, Julie A.
Format: Article
Language:English
Subjects:
Decision making
Medicare
Mortality
Older people
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by
cites cdi_FETCH-LOGICAL-c406t-ee916d729aa50cda7b608c8e91f68dd122a513af1dbfc4fd9e0153ed280675923
container_end_page 21514593231216390
container_issue
container_start_page 21514593231216390
container_title Geriatric orthopaedic surgery & rehabilitation
container_volume 14
creator Abernathy, Bailey R.
Huyke-Hernández, Fernando A.
Rivard, Rachael L.
Schroder, Lisa K.
Switzer, Julie A.
description Introduction A care conundrum for low-energy pelvic ring fracture patients in which they face financial burden after not qualifying for an inpatient stay of 3 days or more has been noted in the literature. The purpose of this study was to identify factors that lead to inpatient length of stay (IP LOS) ≥3 days in older adults with nonoperative pelvic ring fragility fractures and to highlight the challenging financial decision-making of those with IP LOS
doi_str_mv 10.1177/21514593231216390
format article
fullrecord <record><control><sourceid>proquest_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_ff8da576bbdd4f4abe4b83cf7846af12</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_21514593231216390</sage_id><doaj_id>oai_doaj_org_article_ff8da576bbdd4f4abe4b83cf7846af12</doaj_id><sourcerecordid>2920194525</sourcerecordid><originalsourceid>FETCH-LOGICAL-c406t-ee916d729aa50cda7b608c8e91f68dd122a513af1dbfc4fd9e0153ed280675923</originalsourceid><addsrcrecordid>eNp1kV1rFDEUhgdRsNT-AO8C3ngzbb4_vFuWrRYWWopeh0xysmaZnazJTGv_vTNdUVHMxUl4ed735HCa5i3Bl4QodUWJIFwYRhmhRDKDXzRni9Yu4ss_3q-bi1r3eD5cMibUWZM234-5pmGHxq-A1q7MJQ_TEMp0QDmibX5sNwOU3RO6g_4heXS_wNfF-XEqUFEa0G0foKBVmPqxfkArdA8PCR4XN6MU3bkxwTDWN82r6PoKFz_v8-bL9ebz-lO7vf14s15tW8-xHFsAQ2RQ1DgnsA9OdRJrr2c1Sh0CodQJwlwkoYuex2AAE8EgUI2lEoay8-bmlBuy29tjSQdXnmx2yT4LueysK2PyPdgYdXBCya4LgUfuOuCdZj4qzeXcYcl6f8o6lvxtgjraQ6oe-t4NkKdqqTZCYYI1mdF3f6H7PJVhntRSQzExXFAxU-RE-ZJrLRB_fZBgu-zS_rPL2XN58lS3g9-p_zf8ALdLnE8</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2920194525</pqid></control><display><type>article</type><title>Exposing the Care Conundrum of Low-Energy Pelvic Ring Fractures in Older Adults: A Review of 322 Patients</title><source>PubMed Central Free</source><source>Publicly Available Content Database</source><source>Sage Journals GOLD Open Access 2024</source><creator>Abernathy, Bailey R. ; Huyke-Hernández, Fernando A. ; Rivard, Rachael L. ; Schroder, Lisa K. ; Switzer, Julie A.</creator><creatorcontrib>Abernathy, Bailey R. ; Huyke-Hernández, Fernando A. ; Rivard, Rachael L. ; Schroder, Lisa K. ; Switzer, Julie A.</creatorcontrib><description>Introduction A care conundrum for low-energy pelvic ring fracture patients in which they face financial burden after not qualifying for an inpatient stay of 3 days or more has been noted in the literature. The purpose of this study was to identify factors that lead to inpatient length of stay (IP LOS) ≥3 days in older adults with nonoperative pelvic ring fragility fractures and to highlight the challenging financial decision-making of those with IP LOS &lt;3 days in the context of the Medicare 3-day rule. Methods This was a retrospective review of 322 patients aged ≥65 presenting from March 2016 and February 2019 to either of 2 emergency departments (EDs) after a ground-level fall resulting in a pelvic ring fracture. Patient demographic, IP LOS, and mortality data were extracted. Case management notes were analyzed to summarize financial decision-making for patients with IP LOS &lt;3 days. Multivariate logistic regression analysis was conducted to identify factors that predicted IP LOS ≥3 days and mortality. Results IP LOS ≥3 days was associated with presentation to level I hospital (OR .30 [.19, 0.50]) and being single (OR 2.50 [1.10, 5.68]). 70.3% required a post-acute skilled nursing facility (SNF) stay. Of patients with LOS &lt;3 days, 25.0% were financially responsible for their SNF stay, while 7.9% elected home care due to financial reasons. Overall 30-day, 90-day, and 1-year mortality were 2.5%, 8.1%, and 20.8%, respectively. For patients with LOS &lt;3 days, returning to assisted living compared to discharging to a SNF increased 90-day mortality risk (HR 8.529, P = .0451). Having Medicare trended towards increased 90-day mortality risk compared to commercial insurance (HR 4.556, P = .0544). Conclusion The current system is failing older adult patients who sustain nonoperative low-energy pelvic ring fractures in terms of financial coverage of necessary post-acute treatment. This care conundrum has yet to be solved.</description><identifier>ISSN: 2151-4593</identifier><identifier>ISSN: 2151-4585</identifier><identifier>EISSN: 2151-4593</identifier><identifier>DOI: 10.1177/21514593231216390</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Decision making ; Medicare ; Mortality ; Older people</subject><ispartof>Geriatric orthopaedic surgery &amp; rehabilitation, 2023-11, Vol.14, p.21514593231216390-21514593231216390</ispartof><rights>The Author(s) 2023</rights><rights>The Author(s) 2023. This work is licensed under the Creative Commons Attribution – Non-Commercial License https://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c406t-ee916d729aa50cda7b608c8e91f68dd122a513af1dbfc4fd9e0153ed280675923</cites><orcidid>0000-0002-4834-1643</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/21514593231216390$$EPDF$$P50$$Gsage$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2920194525?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,21966,25753,27853,27924,27925,37012,37013,44590,44945,45333</link.rule.ids></links><search><creatorcontrib>Abernathy, Bailey R.</creatorcontrib><creatorcontrib>Huyke-Hernández, Fernando A.</creatorcontrib><creatorcontrib>Rivard, Rachael L.</creatorcontrib><creatorcontrib>Schroder, Lisa K.</creatorcontrib><creatorcontrib>Switzer, Julie A.</creatorcontrib><title>Exposing the Care Conundrum of Low-Energy Pelvic Ring Fractures in Older Adults: A Review of 322 Patients</title><title>Geriatric orthopaedic surgery &amp; rehabilitation</title><description>Introduction A care conundrum for low-energy pelvic ring fracture patients in which they face financial burden after not qualifying for an inpatient stay of 3 days or more has been noted in the literature. The purpose of this study was to identify factors that lead to inpatient length of stay (IP LOS) ≥3 days in older adults with nonoperative pelvic ring fragility fractures and to highlight the challenging financial decision-making of those with IP LOS &lt;3 days in the context of the Medicare 3-day rule. Methods This was a retrospective review of 322 patients aged ≥65 presenting from March 2016 and February 2019 to either of 2 emergency departments (EDs) after a ground-level fall resulting in a pelvic ring fracture. Patient demographic, IP LOS, and mortality data were extracted. Case management notes were analyzed to summarize financial decision-making for patients with IP LOS &lt;3 days. Multivariate logistic regression analysis was conducted to identify factors that predicted IP LOS ≥3 days and mortality. Results IP LOS ≥3 days was associated with presentation to level I hospital (OR .30 [.19, 0.50]) and being single (OR 2.50 [1.10, 5.68]). 70.3% required a post-acute skilled nursing facility (SNF) stay. Of patients with LOS &lt;3 days, 25.0% were financially responsible for their SNF stay, while 7.9% elected home care due to financial reasons. Overall 30-day, 90-day, and 1-year mortality were 2.5%, 8.1%, and 20.8%, respectively. For patients with LOS &lt;3 days, returning to assisted living compared to discharging to a SNF increased 90-day mortality risk (HR 8.529, P = .0451). Having Medicare trended towards increased 90-day mortality risk compared to commercial insurance (HR 4.556, P = .0544). Conclusion The current system is failing older adult patients who sustain nonoperative low-energy pelvic ring fractures in terms of financial coverage of necessary post-acute treatment. This care conundrum has yet to be solved.</description><subject>Decision making</subject><subject>Medicare</subject><subject>Mortality</subject><subject>Older people</subject><issn>2151-4593</issn><issn>2151-4585</issn><issn>2151-4593</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>AFRWT</sourceid><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNp1kV1rFDEUhgdRsNT-AO8C3ngzbb4_vFuWrRYWWopeh0xysmaZnazJTGv_vTNdUVHMxUl4ed735HCa5i3Bl4QodUWJIFwYRhmhRDKDXzRni9Yu4ss_3q-bi1r3eD5cMibUWZM234-5pmGHxq-A1q7MJQ_TEMp0QDmibX5sNwOU3RO6g_4heXS_wNfF-XEqUFEa0G0foKBVmPqxfkArdA8PCR4XN6MU3bkxwTDWN82r6PoKFz_v8-bL9ebz-lO7vf14s15tW8-xHFsAQ2RQ1DgnsA9OdRJrr2c1Sh0CodQJwlwkoYuex2AAE8EgUI2lEoay8-bmlBuy29tjSQdXnmx2yT4LueysK2PyPdgYdXBCya4LgUfuOuCdZj4qzeXcYcl6f8o6lvxtgjraQ6oe-t4NkKdqqTZCYYI1mdF3f6H7PJVhntRSQzExXFAxU-RE-ZJrLRB_fZBgu-zS_rPL2XN58lS3g9-p_zf8ALdLnE8</recordid><startdate>20231101</startdate><enddate>20231101</enddate><creator>Abernathy, Bailey R.</creator><creator>Huyke-Hernández, Fernando A.</creator><creator>Rivard, Rachael L.</creator><creator>Schroder, Lisa K.</creator><creator>Switzer, Julie A.</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><general>SAGE Publishing</general><scope>AFRWT</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-4834-1643</orcidid></search><sort><creationdate>20231101</creationdate><title>Exposing the Care Conundrum of Low-Energy Pelvic Ring Fractures in Older Adults: A Review of 322 Patients</title><author>Abernathy, Bailey R. ; Huyke-Hernández, Fernando A. ; Rivard, Rachael L. ; Schroder, Lisa K. ; Switzer, Julie A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c406t-ee916d729aa50cda7b608c8e91f68dd122a513af1dbfc4fd9e0153ed280675923</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Decision making</topic><topic>Medicare</topic><topic>Mortality</topic><topic>Older people</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abernathy, Bailey R.</creatorcontrib><creatorcontrib>Huyke-Hernández, Fernando A.</creatorcontrib><creatorcontrib>Rivard, Rachael L.</creatorcontrib><creatorcontrib>Schroder, Lisa K.</creatorcontrib><creatorcontrib>Switzer, Julie A.</creatorcontrib><collection>Sage Journals GOLD Open Access 2024</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Geriatric orthopaedic surgery &amp; rehabilitation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abernathy, Bailey R.</au><au>Huyke-Hernández, Fernando A.</au><au>Rivard, Rachael L.</au><au>Schroder, Lisa K.</au><au>Switzer, Julie A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Exposing the Care Conundrum of Low-Energy Pelvic Ring Fractures in Older Adults: A Review of 322 Patients</atitle><jtitle>Geriatric orthopaedic surgery &amp; rehabilitation</jtitle><date>2023-11-01</date><risdate>2023</risdate><volume>14</volume><spage>21514593231216390</spage><epage>21514593231216390</epage><pages>21514593231216390-21514593231216390</pages><issn>2151-4593</issn><issn>2151-4585</issn><eissn>2151-4593</eissn><abstract>Introduction A care conundrum for low-energy pelvic ring fracture patients in which they face financial burden after not qualifying for an inpatient stay of 3 days or more has been noted in the literature. The purpose of this study was to identify factors that lead to inpatient length of stay (IP LOS) ≥3 days in older adults with nonoperative pelvic ring fragility fractures and to highlight the challenging financial decision-making of those with IP LOS &lt;3 days in the context of the Medicare 3-day rule. Methods This was a retrospective review of 322 patients aged ≥65 presenting from March 2016 and February 2019 to either of 2 emergency departments (EDs) after a ground-level fall resulting in a pelvic ring fracture. Patient demographic, IP LOS, and mortality data were extracted. Case management notes were analyzed to summarize financial decision-making for patients with IP LOS &lt;3 days. Multivariate logistic regression analysis was conducted to identify factors that predicted IP LOS ≥3 days and mortality. Results IP LOS ≥3 days was associated with presentation to level I hospital (OR .30 [.19, 0.50]) and being single (OR 2.50 [1.10, 5.68]). 70.3% required a post-acute skilled nursing facility (SNF) stay. Of patients with LOS &lt;3 days, 25.0% were financially responsible for their SNF stay, while 7.9% elected home care due to financial reasons. Overall 30-day, 90-day, and 1-year mortality were 2.5%, 8.1%, and 20.8%, respectively. For patients with LOS &lt;3 days, returning to assisted living compared to discharging to a SNF increased 90-day mortality risk (HR 8.529, P = .0451). Having Medicare trended towards increased 90-day mortality risk compared to commercial insurance (HR 4.556, P = .0544). Conclusion The current system is failing older adult patients who sustain nonoperative low-energy pelvic ring fractures in terms of financial coverage of necessary post-acute treatment. This care conundrum has yet to be solved.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><doi>10.1177/21514593231216390</doi><orcidid>https://orcid.org/0000-0002-4834-1643</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 2151-4593
ispartof Geriatric orthopaedic surgery & rehabilitation, 2023-11, Vol.14, p.21514593231216390-21514593231216390
issn 2151-4593
2151-4585
2151-4593
language eng
recordid cdi_doaj_primary_oai_doaj_org_article_ff8da576bbdd4f4abe4b83cf7846af12
source PubMed Central Free; Publicly Available Content Database; Sage Journals GOLD Open Access 2024
subjects Decision making
Medicare
Mortality
Older people
title Exposing the Care Conundrum of Low-Energy Pelvic Ring Fractures in Older Adults: A Review of 322 Patients
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-04T05%3A12%3A12IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Exposing%20the%20Care%20Conundrum%20of%20Low-Energy%20Pelvic%20Ring%20Fractures%20in%20Older%20Adults:%20A%20Review%20of%20322%20Patients&rft.jtitle=Geriatric%20orthopaedic%20surgery%20&%20rehabilitation&rft.au=Abernathy,%20Bailey%20R.&rft.date=2023-11-01&rft.volume=14&rft.spage=21514593231216390&rft.epage=21514593231216390&rft.pages=21514593231216390-21514593231216390&rft.issn=2151-4593&rft.eissn=2151-4593&rft_id=info:doi/10.1177/21514593231216390&rft_dat=%3Cproquest_doaj_%3E2920194525%3C/proquest_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c406t-ee916d729aa50cda7b608c8e91f68dd122a513af1dbfc4fd9e0153ed280675923%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2920194525&rft_id=info:pmid/&rft_sage_id=10.1177_21514593231216390&rfr_iscdi=true