Accuracy of evidence-based criteria for identifying an incident hip fracture in the absence of the date of injury: a retrospective database study
- Vu, Trang, Davie, Gabrielle, Barson, David, Day, Lesley, Finch, Caroline
- Authors: Vu, Trang , Davie, Gabrielle , Barson, David , Day, Lesley , Finch, Caroline
- Date: 2013
- Type: Text , Journal article
- Relation: BMJ Open Vol. 3, no. 7 (2013), p. 1-6
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text:
- Reviewed:
- Description: Objectives: Hospital discharge data (HDD) in many health systems do not capture the date of injury (DOI); the absence of this date hinders researchers’ ability to distinguish repeat from incident injury admissions. Various approaches using somewhat arbitrary criteria have been explored to increase the accuracy of incident injury identification. However, these approaches have not been validated against a data source which contains DOI. The aim of this study was to determine the accuracy of evidence-based criteria for identifying fall-related incident hip fractures in the absence of DOI using HDD containing DOI as the reference standard. Design: Retrospective database study. Setting: New Zealand. Participants: 8761 patients aged 65+ years admitted for fall-related hip fracture between 1 July 2005 and 30 June 2008, inclusive. Outcome measures: We defined person-identifying HDD containing DOI as the reference standard and calculated measures of the accuracy of evidence-based criteria for identifying fall-related incident hip fractures from HDD not containing DOI. The criteria were principal diagnosis of hip fracture, mechanism of injury indicating a fall, admission type emergency, admission source other than a transfer and presence of hip operation code(s). For a subsequent fall-related hip fracture, additional criteria were time between successive hip fractures ≥120 days, and all external cause-of-injury codes being different to those for the previous hip fracture. Results: The sensitivity and specificity of the criteria for identifying fall-related incident hip fractures from data not containing DOI were 96.7% and 99.3%, respectively, compared with the reference standard. The application of these criteria resulted in a slight underestimation of the percentage of patients with multiple hip fractures. Conclusions: Although it is preferable to have DOI; this study demonstrates that evidence-based criteria can be used to reliably identify fall-related incident hip fractures from the person-identifying HDD when DOI is unavailable.
- Authors: Vu, Trang , Davie, Gabrielle , Barson, David , Day, Lesley , Finch, Caroline
- Date: 2013
- Type: Text , Journal article
- Relation: BMJ Open Vol. 3, no. 7 (2013), p. 1-6
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text:
- Reviewed:
- Description: Objectives: Hospital discharge data (HDD) in many health systems do not capture the date of injury (DOI); the absence of this date hinders researchers’ ability to distinguish repeat from incident injury admissions. Various approaches using somewhat arbitrary criteria have been explored to increase the accuracy of incident injury identification. However, these approaches have not been validated against a data source which contains DOI. The aim of this study was to determine the accuracy of evidence-based criteria for identifying fall-related incident hip fractures in the absence of DOI using HDD containing DOI as the reference standard. Design: Retrospective database study. Setting: New Zealand. Participants: 8761 patients aged 65+ years admitted for fall-related hip fracture between 1 July 2005 and 30 June 2008, inclusive. Outcome measures: We defined person-identifying HDD containing DOI as the reference standard and calculated measures of the accuracy of evidence-based criteria for identifying fall-related incident hip fractures from HDD not containing DOI. The criteria were principal diagnosis of hip fracture, mechanism of injury indicating a fall, admission type emergency, admission source other than a transfer and presence of hip operation code(s). For a subsequent fall-related hip fracture, additional criteria were time between successive hip fractures ≥120 days, and all external cause-of-injury codes being different to those for the previous hip fracture. Results: The sensitivity and specificity of the criteria for identifying fall-related incident hip fractures from data not containing DOI were 96.7% and 99.3%, respectively, compared with the reference standard. The application of these criteria resulted in a slight underestimation of the percentage of patients with multiple hip fractures. Conclusions: Although it is preferable to have DOI; this study demonstrates that evidence-based criteria can be used to reliably identify fall-related incident hip fractures from the person-identifying HDD when DOI is unavailable.
- Vu, Trang, Finch, Caroline, Day, Lesley
- Authors: Vu, Trang , Finch, Caroline , Day, Lesley
- Date: 2012
- Type: Text , Journal article
- Relation: Injury Prevention Vol. 18, no. Supplement 1 (2012), p. A121
- Full Text: false
- Reviewed:
- Description: Background: Nearly half to 60% of falls in community-dwelling older people aged 65+ years result in physical injuries and 20%–50% of these require medical attention, including emergency department visit and hospitalisation. Fallers who stay in hospital longer than would be expected based on the primary injury diagnosis create an excess financial burden on the health system and represent a priority target group for fall prevention. Objectives: To identify and characterise high-length-of-stay (HLOS) patients among community-dwelling older people aged 65+ years hospitalised for fall-related injury. Methods: We analysed hospital discharge data from Victoria, Australia, to identify and characterise HLOS patients among community-dwelling older people aged 65+ years hospitalised for fall-related injury. We defined an episode as HLOS if the length of stay (LOS) was more than three times the average LOS for a particular diagnosis-related group. Results: Between 2005/06 and 2007/08 6822 patients (14.2% of the study group of which 73.8% were women) had ≥1 episode classified as HLOS. The HLOS patients accounted for 19.9% of episodes and 39.9% of bed days. HLOS patients were similar to non-HLOS patients in terms of indigenous status, in-hospital mortality and ethnicity. However, HLOS patients were older, less likely to be married, less likely to have hospital insurance and more likely to have comorbidity than non-HLOS patients. Significance/Contribution to the Field: This study identifies priority groups for a targeted prevention approach.
- Haines, Terry, Hill, Keith, Vu, Trang, Clemson, Lindy, Finch, Caroline, Day, Lesley
- Authors: Haines, Terry , Hill, Keith , Vu, Trang , Clemson, Lindy , Finch, Caroline , Day, Lesley
- Date: 2016
- Type: Text , Journal article
- Relation: Archives of Gerontology and Geriatrics Vol. 64, no. (2016), p. 151-161
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text: false
- Reviewed:
- Description: Background: Exercise for falls prevention is effective but of limited uptake in real life. The link between intention and behavior is central to many health-behavior models, but has not been examined in the falls prevention exercise context. Objective: This study examines this relationship and prospectively identifies factors associated with participation in group and home-based falls prevention exercise. Design: This was an observational study of community-dwelling adults in Australia >70 years of age with a 12 month follow-up (n = 394 commenced baseline assessment, n = 247 commenced follow-up). Methods: Intention, and other potential predictive factors examined, were measured at baseline while participation was measured using self-report at 12 month follow-up. Results: Between 65% and 72% of our sample at baseline agreed or strongly agreed they would participate in the falls prevention exercise programs. n = 27 respondents participated in home-based exercise during follow-up and had intention to do so while n = 29 who participated did not have intention. In contrast, n = 43 respondents participated in group exercise and had intention to do so compared to 11 who participated but did not intend to at baseline. Perception of personal effectiveness and previous exposure to the exercise intervention were most strongly predictive of future participation. Conclusion: More people who do not want to participate in home exercise actually participate in home exercise than people who do not want to participate in group exercise that actually do. It may be easier to convince people who do not want to participate in falls prevention exercise to participate in a home program. © 2016 Elsevier Ireland Ltd.
Linked versus unlinked hospital discharge data on hip fractures for estimating incidence and comorbidity profiles
- Vu, Trang, Day, Lesley, Finch, Caroline
- Authors: Vu, Trang , Day, Lesley , Finch, Caroline
- Date: 2012
- Type: Text , Journal article
- Relation: BMC Medical Research Methodology Vol. 12, no. 113 (2012), p. 1-8
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text:
- Reviewed:
- Description: Background: Studies comparing internally linked (person–identifying) and unlinked (episodes of care) hospital discharge data (HDD) on hip fractures have mainly focused on incidence overestimation by unlinked HDD, but little is known about the impact of overestimation on patient profiles such as comorbidity estimates. In view of the continuing use of unlinked HDD in hip fracture research and the desire to apply research results to hip fracture prevention, we concurrently assessed the accuracy of both incidence and comorbidity estimates derived from unlinked HDD compared to those estimated from internally linked HDD. Methods: We analysed unlinked and internally linked HDD between 01 July 2005 and 30 June 2008, inclusive, from Victoria, Australia to estimate the incidence of hospital admission for fall-related hip fracture in community-dwelling older people aged 65+ years and determine the prevalence of comorbidity in patients. Community-dwelling status was defined as living in private residence, supported residential facilities or special accommodation but not in nursing homes. We defined internally linked HDD as the reference standard and calculated measures of accuracy of fall-related hip fracture incidence by unlinked HDD using standard definitions. The extent to which comorbidity prevalence estimates by unlinked HDD differed from those by the reference standard was assessed in absolute terms. Results: The sensitivity and specificity of a standard approach for estimating fall-related hip fracture incidence using unlinked HDD (i.e. omitting records of in-hospital deaths, inter-hospital transfers and readmissions within 30 days of discharge) were 94.4% and 97.5%, respectively. The standard approach and its variants underestimated the prevalence of some comorbidities and altered their ranking. The use of more stringent selection criteria led to major improvements in all measures of accuracy as well as overall and specific comorbidity estimates. Conclusions: This study strongly supports the use of linked rather than unlinked HDD in injury research. In health systems where linked HDD are unavailable, current approaches for identifying incident hip fractures may be enhanced by incorporating additional evidence-based criteria.
- Authors: Vu, Trang , Day, Lesley , Finch, Caroline
- Date: 2012
- Type: Text , Journal article
- Relation: BMC Medical Research Methodology Vol. 12, no. 113 (2012), p. 1-8
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text:
- Reviewed:
- Description: Background: Studies comparing internally linked (person–identifying) and unlinked (episodes of care) hospital discharge data (HDD) on hip fractures have mainly focused on incidence overestimation by unlinked HDD, but little is known about the impact of overestimation on patient profiles such as comorbidity estimates. In view of the continuing use of unlinked HDD in hip fracture research and the desire to apply research results to hip fracture prevention, we concurrently assessed the accuracy of both incidence and comorbidity estimates derived from unlinked HDD compared to those estimated from internally linked HDD. Methods: We analysed unlinked and internally linked HDD between 01 July 2005 and 30 June 2008, inclusive, from Victoria, Australia to estimate the incidence of hospital admission for fall-related hip fracture in community-dwelling older people aged 65+ years and determine the prevalence of comorbidity in patients. Community-dwelling status was defined as living in private residence, supported residential facilities or special accommodation but not in nursing homes. We defined internally linked HDD as the reference standard and calculated measures of accuracy of fall-related hip fracture incidence by unlinked HDD using standard definitions. The extent to which comorbidity prevalence estimates by unlinked HDD differed from those by the reference standard was assessed in absolute terms. Results: The sensitivity and specificity of a standard approach for estimating fall-related hip fracture incidence using unlinked HDD (i.e. omitting records of in-hospital deaths, inter-hospital transfers and readmissions within 30 days of discharge) were 94.4% and 97.5%, respectively. The standard approach and its variants underestimated the prevalence of some comorbidities and altered their ranking. The use of more stringent selection criteria led to major improvements in all measures of accuracy as well as overall and specific comorbidity estimates. Conclusions: This study strongly supports the use of linked rather than unlinked HDD in injury research. In health systems where linked HDD are unavailable, current approaches for identifying incident hip fractures may be enhanced by incorporating additional evidence-based criteria.
Patterns of comorbidity in community-dwelling older people hospitalised for fall-related injury: A cluster analysis
- Vu, Trang, Finch, Caroline, Day, Lesley
- Authors: Vu, Trang , Finch, Caroline , Day, Lesley
- Date: 2011
- Type: Text , Journal article
- Relation: BMC Geriatrics Vol. 11, no. 45 (2011), p. 1-10
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text:
- Reviewed:
- Description: Background: Community-dwelling older people aged 65+ years sustain falls frequently; these can result in physical injuries necessitating medical attention including emergency department care and hospitalisation. Certain health conditions and impairments have been shown to contribute independently to the risk of falling or experiencing a fall injury, suggesting that individuals with these conditions or impairments should be the focus of falls prevention. Since older people commonly have multiple conditions/impairments, knowledge about which conditions/impairments coexist in at-risk individuals would be valuable in the implementation of a targeted prevention approach. The objective of this study was therefore to examine the prevalence and patterns of comorbidity in this population group. Methods: We analysed hospitalisation data from Victoria, Australia's second most populous state, to estimate the prevalence of comorbidity in patients hospitalised at least once between 2005-6 and 2007-8 for treatment of acute fall-related injuries. In patients with two or more comorbid conditions (multicomorbidity) we used an agglomerative hierarchical clustering method to cluster comorbidity variables and identify constellations of conditions. Results: More than one in four patients had at least one comorbid condition and among patients with comorbidity one in three had multicomorbidity (range 2-7). The prevalence of comorbidity varied by gender, age group, ethnicity and injury type; it was also associated with a significant increase in the average cumulative length of stay per patient. The cluster analysis identified five distinct, biologically plausible clusters of comorbidity: cardiopulmonary/metabolic, neurological, sensory, stroke and cancer. The cardiopulmonary/metabolic cluster was the largest cluster among the clusters identified. Conclusions: The consequences of comorbidity clustering in terms of falls and/or injury outcomes of hospitalised patients should be investigated by future studies. Our findings have particular relevance for falls prevention strategies, clinical practice and planning of follow-up services for these patients.
- Authors: Vu, Trang , Finch, Caroline , Day, Lesley
- Date: 2011
- Type: Text , Journal article
- Relation: BMC Geriatrics Vol. 11, no. 45 (2011), p. 1-10
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text:
- Reviewed:
- Description: Background: Community-dwelling older people aged 65+ years sustain falls frequently; these can result in physical injuries necessitating medical attention including emergency department care and hospitalisation. Certain health conditions and impairments have been shown to contribute independently to the risk of falling or experiencing a fall injury, suggesting that individuals with these conditions or impairments should be the focus of falls prevention. Since older people commonly have multiple conditions/impairments, knowledge about which conditions/impairments coexist in at-risk individuals would be valuable in the implementation of a targeted prevention approach. The objective of this study was therefore to examine the prevalence and patterns of comorbidity in this population group. Methods: We analysed hospitalisation data from Victoria, Australia's second most populous state, to estimate the prevalence of comorbidity in patients hospitalised at least once between 2005-6 and 2007-8 for treatment of acute fall-related injuries. In patients with two or more comorbid conditions (multicomorbidity) we used an agglomerative hierarchical clustering method to cluster comorbidity variables and identify constellations of conditions. Results: More than one in four patients had at least one comorbid condition and among patients with comorbidity one in three had multicomorbidity (range 2-7). The prevalence of comorbidity varied by gender, age group, ethnicity and injury type; it was also associated with a significant increase in the average cumulative length of stay per patient. The cluster analysis identified five distinct, biologically plausible clusters of comorbidity: cardiopulmonary/metabolic, neurological, sensory, stroke and cancer. The cardiopulmonary/metabolic cluster was the largest cluster among the clusters identified. Conclusions: The consequences of comorbidity clustering in terms of falls and/or injury outcomes of hospitalised patients should be investigated by future studies. Our findings have particular relevance for falls prevention strategies, clinical practice and planning of follow-up services for these patients.
- Vu, Trang, Day, Lesley, Finch, Caroline
- Authors: Vu, Trang , Day, Lesley , Finch, Caroline
- Date: 2014
- Type: Text , Journal article
- Relation: Australian and New Zealand Journal of Public Health Vol. 38, no. 2 (April 2014), p. 128-133
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text: false
- Reviewed:
- Description: Objective: To estimate the burden of hospitalised fall-related injury in community-dwelling older people in Victoria. Methods: We analysed fall-related, person-identifying hospital discharge data and patient-level hospital treatment costs for community-dwelling older people aged 65+ years from Victoria between 1 July 2005 and 30 June 2008, inclusive. Key outcomes of interest were length of stay (LOS)/episode, cumulative LOS (CLOS)/patient and inpatient costs. Results: The burden of hospitalised fall-related injury in community-dwelling older people aged 65+ years in Victoria was 284,781 hospital bed days in 2005-06, rising to 310,031 hospital bed days in 2007-08. Seventy-one per cent of episodes were multiday. One in 15 acute care episodes was a high LOS outlier and 14% of patients had ≥1 episode classified as high LOS outlier. The median CLOS/patient was nine days (interquartile range 2-27). The annual costs of inpatient care, in June 2009 prices, for fall-related injury in community-dwelling people aged 65+ years in Victoria rose from $213 million in 2005-06 to $237 million in 2007-08. The burden of hospitalised fall-related injury in community-dwelling older women, people aged 85+ years and those with comorbidity was considerable. Conclusions: The burden of hospitalised fall-related injury in community-dwelling older people aged 65+ years in Victoria is significantly more than previously projected. Importantly, this study identifies that women, patients with comorbidity and those aged 85+ years account for a considerable proportion of this burden. Implications: A corresponding increase in falls prevention effort is required to ensure that the burden is properly addressed.
- «
- ‹
- 1
- ›
- »