Date of Award

11-19-2014

Document Type

Dissertation

Copyright Status for Dissertations

All Rights Reserved

Degree Name

Doctor of Philosophy (Ph.D.) Nursing

Department

Nursing

First Advisor

Veronica D Feeg

Abstract

The percentage of the U.S. population that is over 65 years of age is expected increase to over 20% by 2040. Within that geriatric population, 50% of women and 20% of men will experience osteoporotic fractures. The cost of their care is estimated in billions of dollars annually. The outcomes from osteoporotic fractures account for more morbidity than all cancers, except lung cancer, combined.

Rapid surgical intervention protocols, which reduce the time between fracture and surgical repair, are intended to improve outcomes and reduce costs. The protocols require intense care coordination and their effectiveness has not been unequivocally established. This study explored the relationships of rapid surgical intervention to the clinical outcomes of in-hospital delirium and pressure ulcer and the economic outcomes of post-procedure length of stay and total hospital charges. These outcomes were investigated through a secondary data analysis of the New York State administrative billing database (SPARCS) from a five-hospital system. The sample included 1,979 subjects from the years of 2010 through 2013; a modified Charlson Co-morbidity and Age Index score was applied to all subjects in order to approximate their admission health status.

Rapid Surgical Intervention was a predictor (p < .001) of lower post-procedure lengths of stay lower total hospital charges, and lower rates of pressure ulcer development. High Modified Charlson Index scores were predictive of higher mortality rates, longer lengths of stay, and higher total charges. Male gender was significant for higher lengths of stay, mortality rates, and pressure ulcer development. Femur/hip fractures were related to longer lengths of stay and higher total charges than other fracture sites, but were not a predictor of mortality or pressure ulcer development.

Related Pillar(s)

Study

Included in

Nursing Commons

Share

COinS