Article Text

Days alive and at home after hip fracture: a cross-sectional validation of a patient-centred outcome measure using routinely collected data
  1. Daniel I McIsaac1,2,
  2. Robert Talarico2,3,
  3. Angela Jerath4,
  4. Duminda N Wijeysundera4,5
  1. 1 Anesthesiology and Pain Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
  2. 2 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  3. 3 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  4. 4 Anesthesia, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  5. 5 St Michael’s Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
  1. Correspondence to Dr Daniel I McIsaac, Anesthesiology & Pain Medicine, University of Ottawa Faculty of Medicine, Ottawa, ON K1H 8M5, Canada; dmcisaac{at}


Background Days alive and at home (DAH) is a patient centered outcome measureable in routinely collected health data. The validity and minimally important difference (MID) in hip fracture have not been evaluated.

Objective We assessed construct and predictive validity and estimated a MID for the patient-centred outcome of DAH after hip fracture admission.

Methods This is a cross-sectional observational study using linked health administrative data in Ontario, Canada. DAH was calculated as the number of days alive within 90 days of admission minus the number of days hospitalised or institutionalised. All hospital admissions (2012–2018) for hip fracture in adults aged >50 years were included. Construct validity analyses used Bayesian quantile regression to estimate the associations of postulated patient, admission and process-related variables with DAH. The predictive validity assessed was the correlation of DAH in 90 days with the value from 91 to 365 days; and the association and discrimination of DAH in 90 days predicting subsequent mortality. MID was estimated by averaging distribution-based and clinical anchor-based estimates.

Results We identified 63 778 patients with hip fracture. The median number of DAH was 43 (range 0–87). In the 90 days after admission, 8050 (12.6%) people died; a further 6366 (10.0%) died from days 91 to 365. Associations between patient-level and admission-level factors with the median DAH (lower with greater age, frailty and comorbidity, lower if admitted to intensive care or having had a complication) supported construct validity. DAH in 90 days after admission was strongly correlated with DAH in 365 days after admission (r=0.922). An 11-day MID was estimated.

Conclusion DAH has face, construct and predictive validity as a patient-centred outcome in patients with hip fracture, with an estimated MID of 11 days. Future research is required to include direct patient perspectives in confirming MID.

  • comparative effectiveness research
  • evaluation methodology
  • health services research
  • patient-centred care
  • surgery

Data availability statement

No data are available. All data used are held as de-identified data at ICES, whose governing privacy legislation does not permit data sharing.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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Data availability statement

No data are available. All data used are held as de-identified data at ICES, whose governing privacy legislation does not permit data sharing.

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  • Contributors DIM, RT, AJ and DNW contributed to conception and design of the study. DIM and RT contributed to acquisition and analysis of data. DIM, RT, AJ and DNW contributed to interpretation of data, drafting the work and gave final approval for publication. DIM, RT, AJ and DNW agree to be accountable for all aspects of the work.

  • Funding The study received funding from the Institute of Health Services and Policy Research (PJT-165805), which is part of the Canadian Institutes of Health Research.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.