Accuracy of Medical Records in Hip Fracture Fox, Kathleen M.; Reuland, Melissa; Hawkes, William G. ...
Journal of the American Geriatrics Society (JAGS),
June 1998, Letnik:
46, Številka:
6
Journal Article
Recenzirano
OBJECTIVE: To determine the accuracy of diagnoses and procedure codes in medical records for hip fracture patients.
DESIGN: A validation sample of hip fracture medical records was used to compare the ...facesheet data with progress notes, operative reports, and discharge summaries for patients in a prospective study of functional recovery.
SETTING: Eight Baltimore hospitals with the highest volume of older hip fracture patients.
PATIENTS: Study subjects were 343 community‐dwelling patients, 65 years of age and older, admitted to one of eight Baltimore hospitals between January 1990 and June 1991 with a diagnosis of hip fracture.
MAIN OUTCOME MEASURES: Facesheet diagnosis codes were compared with admitting notes, discharge summary, and/or progress notes. The ed surgical procedure was compared with postoperative radiographs.
RESULTS: Excess coding of diagnoses on the hospital facesheet was evident in 12% of charts. In 17% of charts, a complication identified in the chart was not coded on the facesheet. More complications with low severity were omitted. Agreement between the or's procedure review and radiograph readings for arthroplasty was 84%. In 15% of patients, the or coded total arthroplasty when hemiarthroplasty was done.
CONCLUSIONS: Discrepancy between the hospital facesheet and the medical record and between the ed surgical procedure and radiographs was found for hip fracture patients. This may make findings from health outcomes research relying on administrative databases uncertain and reimbursement inaccurate.
Predictors of bone loss after hip fracture WEHREN, Lois E; HAWKES, William G; HEBEL, J. Richard ...
Osteoporosis international,
02/2004, Letnik:
15, Številka:
2
Journal Article
Recenzirano
Although accelerated bone mineral density (BMD) loss follows hip fracture, little is known about factors associated with this loss. We examined potential predictors of BMD loss in a cohort of ...community-dwelling women who had sustained hip fracture and who were followed for 1 year after fracture. BMD was measured at the femoral neck, intertrochanteric region, and total body, during hospitalization and 2, 6, and 12 months later. Demographic, health, lifestyle, clinical, surgical, and functional characteristics at baseline, and postfracture activity were evaluated for associations with baseline BMD and BMD 1 year later. To examine possible BMD-dependent effects, high and low baseline BMD groups were defined. None of the studied factors consistently predicted either baseline BMD or BMD at 1 year after fracture, among women with either high or low baseline BMD. Baseline BMD was the only factor that substantially and consistently predicted change, explaining 70% to 90% of variation. These results suggest that BMD will not be preserved by general rehabilitative measures and that prompt, specific intervention to minimize bone loss after hip fracture is an essential element of clinical management of the hip fracture patient.
To determine whether there is a group of recent hip fracture patients who exhibit the signs of failure to thrive and to identify potential precursors to their decline in physical functioning.
...Prospective (nonintervention) study of hip fracture recovery; patients were assessed in the hospital and at 2, 6, 12, 18, and 24 months post-fracture.
Hip fracture patients admitted to one of eight Baltimore area hospitals from the community with a new fracture of the proximal femur between January 1, 1990, and June 15, 1991.
Patients were 65 years of age and older and lived in the community before the fracture. A total of 804 patients were eligible for the study; the present study analyses were restricted to the 252 patients who survived 1 year and had a self-report assessment at 6 and 12 months post-fracture.
A questionnaire administered during hospitalization assessed pre-fracture functional and health status and current affective and cognitive status. In-home interviews post-fracture ascertained dependence and difficulty with physical and instrumental activities of daily living. Abstraction of the medical records provided information about comorbidities, surgical procedure, and hospital length of stay.
Patients who declined in ability to walk from 6 to 12 months post-fracture had greater use of health resources (more hospitalizations) and poorer physical functioning up to 2 years post-fracture. Impaired function in physical activities of daily living at 6 months, high glucose, calcium, and CO2 at admission, and low BUN and creatinine at admission were more prevalent among decliners than among non-decliners.
Findings indicate that certain older hip fracture patients begin to exhibit signs and symptoms of failure to thrive. About 10% of patients who survived at least 1 year after fracture could not retain their recovery level of functioning after 6 months and began to decline further. High glucose and CO2 and low BUN and creatinine on hospital admission were associated with later functional decline among hip fracture patients, but their clinical significance is uncertain.
Frequent manual repositioning is an established part of pressure ulcer (PU) prevention, but there is little evidence for its effectiveness. This study examined the association between repositioning ...and PU incidence among bedbound elderly hip fracture patients, using data from a 2004–2007 cohort study in nine Maryland and Pennsylvania hospitals. Eligible patients (n=269) were age≥65 years, underwent hip fracture surgery, and were bedbound at index study visits (during the first five days of hospitalization). Information about repositioning on the days of index visits was collected from patient charts; study nurses assessed presence of PU stage 2+ two days later. The association between frequent manual repositioning and PU incidence was estimated, adjusting for PU risk factors using generalized estimating equations and weighted estimating equations. Patients were frequently repositioned (at least every two hours) on only 53% (187/354) of index visit days. New PU developed at 12% of visits following frequent repositioning versus 10% following less frequent repositioning; the incidence rate of PU per person-day did not differ between the two groups (incidence rate ratio 1.1, 95% confidence interval 0.5–2.4). No association was found between frequent repositioning of bedbound patients and lower PU incidence, calling into question the allocation of resources for repositioning.
Does group discussion and deliberation on one issue or task influence the members' decisions or opinions on other issues? In contrast to past research looking solely at changes in responses to the ...same item discussed by the group, this study examined whether group interaction results in members changing the way they make judgments on related items in the future. The results show that group discussion and consensus on one set of judgments led to a significant convergence of judgmental strategies that extended to a related (but different) set of judgments the members made later as individuals.
Invertebrates constitute the majority of animal species and are critical for ecosystem functioning and services. Nonetheless, global invertebrate biodiversity patterns and their congruences with ...vertebrates remain largely unknown. We resolve the first high-resolution (~20-km) global diversity map for a major invertebrate clade, ants, using biodiversity informatics, range modeling, and machine learning to synthesize existing knowledge and predict the distribution of undiscovered diversity. We find that ants and different vertebrate groups have distinct features in their patterns of richness and rarity, underscoring the need to consider a diversity of taxa in conservation. However, despite their phylogenetic and physiological divergence, ant distributions are not highly anomalous relative to variation among vertebrate clades. Furthermore, our models predict that rarity centers largely overlap (78%), suggesting that general forces shape endemism patterns across taxa. This raises confidence that conservation of areas important for small-ranged vertebrates will benefit invertebrates while providing a “treasure map” to guide future discovery.
A high-resolution map of ant diversity allows an assessment of how well biodiversity centers overlap across taxa.
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