Eight-year outcome associated with clinical options in the management of femoral neck fractures.

This study involved a review of the medical records of 367 patients treated surgically after femoral neck fracture. Linkage of these records with claims files from the Health Care Financing Administration allowed as many as 8 years of followup to analyze the rates of hospital readmission rates for revision, other postoperative complications and mortality. The results revealed: (1) a significantly higher revision rate was associated with internal fixation for the treatment of displaced femoral neck fractures in patients older than 80 years of age; no differences in revision rates were seen between internal fixation or hemiarthroplasty for the treatment of nondisplaced femoral neck fractures in this patient age group; (2) no differences in revision rates were found between internal fixation or hemiarthroplasty for the treatment of displaced femoral neck fractures in patients between the ages of 65 to 80 years; (3) a significantly higher mortality rate was associated with internal fixation than hemiarthroplasty for patients who were between the ages of 65 and 80 years; and (4) no differences in medical or surgical complications, revision rates, or other outcomes were found between unipolar and bipolar prostheses, or between anterior and posterior surgical approaches for hemiarthroplasty in patients who were age 65 years or older.

What physicians should know about small area variation analysis.

Geographic variations in the use of medical care may occur because of differences in patient severity of illness, patient access or use of medical care, physician practice patterns, availability of technology, economic incentives, and malpractice concerns. These variations are leading to greater scrutiny of appropriateness and cost effectiveness of medical care.

Problems in health data analysis: the Maryland permanent pacemaker experience in 1979 and 1980.

In a recent report the Maryland statewide health data base, which is derived from "face sheet" data, was used to determine the appropriateness of permanent pacemaker insertion. In the present study the same indications were utilized and both the complete medical records and the face sheet were reviewed for those patients who had been classified as having permanent pacemakers inserted for inappropriate or questionable reasons. In 32 hospitals, 75% of the records were reviewed (610 of 817 patients).