Trang Vu

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.

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.

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.

The article explores the experiences of patients undergoing day surgery in an Australian public hospital for women. We draw primarily on interviews with these patients to identify the factors arising from the specific context which compromised their well-being.

The aim of the study was to explore the experiences of Australian public and private patients undergoing gynaecological day surgery in a public hospital. A telephone survey was conducted with 315 women within two days of hospital discharge. The findings indicate that patients generally favour the "in and out" experience of day surgery, with some reservations. Prior to hospital admission, private patients were less likely to have access to multiple sources of information as well as information that they found easy to understand. Alternative means of supporting women recovering from day surgery may be needed for those whose family members and/or friends cannot provide sufficient support following discharge. This study contributes to discussion on setting objective standards to evaluate the health system in the field of day surgery.