{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T10:07:51Z","timestamp":1777975671013,"version":"3.51.4"},"reference-count":28,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T00:00:00Z","timestamp":1750723200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AG058878"],"award-info":[{"award-number":["R01AG058878"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe differences in regionalization of hip fracture care and the volume\u2010outcome relationship in five countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>We conducted a population\u2010based cross\u2010sectional cohort study in Canada, Israel, the Netherlands, Taiwan, and the United States. Within each country, we stratified patients into quintiles based upon the volume of hip fractures in the hospital where they were treated. We measured regionalization by the proportion of acute\u2010care hospitals that treated patients with hip fractures and summarized the hospital volume distribution by the ratio of hip fracture volumes for high\u2010volume hospitals versus low\u2010volume hospitals. We then examined age\u2010 and sex\u2010standardized outcomes and treatment for patients treated at high\u2010volume and low\u2010volume hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>We used nationally representative administrative data on adults aged \u2265\u200966\u2009years hospitalized with hip fracture from 2011 to 2019. We followed them until death or 365\u2009days after the discharge date.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>Across countries, the percentage of all acute\u2010care hospitals that treated hip fractures differed widely (from 37.0% in Canada to 82.8% in Israel), with high\u2010volume hospitals treating 4\u201314 times as many hip fractures as low\u2010volume hospitals. The absolute risk\u2010adjusted difference in 30\u2010day mortality for high\u2010volume compared to low\u2010volume hospitals ranged between (\u22121.9% [95% CI, \u22122.2 to \u22121.7] in Canada and +1.1% [95% CI, 0.4\u20131.8] in the Netherlands). The proportion of patients receiving non\u2010operative fracture treatment was lower in high\u2010volume hospitals than low\u2010volume hospitals in all countries (\u22125.4% [95% CI, \u22126.5 to \u22124.3] in Israel to \u22120.1% [95% CI, \u22120.5 to 0.3] in the Netherlands).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Hip fracture regionalization differed substantially across countries. The direction and the magnitude of association between greater regionalization and improved patient outcomes were inconsistent across countries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70002","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T05:35:40Z","timestamp":1750743340000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Regionalization of Hip Fracture Care in Five High\u2010Income Countries"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7749-3091","authenticated-orcid":false,"given":"Pieter","family":"Bakx","sequence":"first","affiliation":[{"name":"Erasmus School of Health Policy &amp; Management Erasmus University Rotterdam  Rotterdam PA the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Godoy","sequence":"additional","affiliation":[{"name":"Erasmus School of Health Policy &amp; Management Erasmus University Rotterdam  Rotterdam PA the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saeed","family":"Al\u2010Azazi","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences University of Manitoba  Winnipeg Manitoba Canada"},{"name":"George &amp; Fay Yee Centre for Healthcare Innovation University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amitava","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Institute of Health Informatics University College London  London UK"},{"name":"Department of Cardiology University College London Hospitals  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nitzan","family":"Burrack","sequence":"additional","affiliation":[{"name":"Clinical Research Center Soroka University Medical Center, Faculty of Health Sciences, ben Gurion University of the Negev  Be'er Sheva Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Ehlig","sequence":"additional","affiliation":[{"name":"Chair of Health Economics, Policy and Management  St. Gallen Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0366-3929","authenticated-orcid":false,"given":"Laura A.","family":"Hatfield","sequence":"additional","affiliation":[{"name":"Department of Statistics and Data Science NORC at the University of Chicago  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asa R.","family":"Hartman","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6629-1176","authenticated-orcid":false,"given":"Nicole","family":"Huang","sequence":"additional","affiliation":[{"name":"Institute of Hospital and Health Care Administration National Yang Ming Chiao Tung University  Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis T.","family":"Ko","sequence":"additional","affiliation":[{"name":"Schulich Heart Program Sunnybrook Health Sciences Centre, Sunnybrook Research Institute Toronto  Toronto Canada"},{"name":"ICES  Toronto Ontario Canada"},{"name":"Department of Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa M.","family":"Lix","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences University of Manitoba  Winnipeg Manitoba Canada"},{"name":"George &amp; Fay Yee Centre for Healthcare Innovation University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominik","family":"Moser","sequence":"additional","affiliation":[{"name":"Chair of Health Economics, Policy and Management  St. Gallen Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor","family":"Novack","sequence":"additional","affiliation":[{"name":"Clinical Research Center Soroka University Medical Center, Faculty of Health Sciences, ben Gurion University of the Negev  Be'er Sheva Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Pasea","sequence":"additional","affiliation":[{"name":"Institute of Health Informatics University College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feng","family":"Qiu","sequence":"additional","affiliation":[{"name":"ICES  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kieran L.","family":"Quinn","sequence":"additional","affiliation":[{"name":"ICES  Toronto Ontario Canada"},{"name":"Department of Medicine University of Toronto  Toronto Ontario Canada"},{"name":"Temmy Latner Centre for Palliative Care Sinai Health, University of Toronto  Toronto Ontario Canada"},{"name":"Institute of Health Policy, Management and Evaluation University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bheeshma","family":"Ravi","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery  Toronto Ontario Canada"},{"name":"Division of Orthopaedic Surgery Sunnybrook Health Sciences Centre  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Therese A.","family":"Stukel","sequence":"additional","affiliation":[{"name":"ICES  Toronto Ontario Canada"},{"name":"Institute of Health Policy, Management and Evaluation University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carin A.","family":"Uyl\u2010de Groot","sequence":"additional","affiliation":[{"name":"Erasmus School of Health Policy &amp; Management Erasmus University Rotterdam  Rotterdam PA the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce E.","family":"Landon","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences University of Manitoba  Winnipeg Manitoba Canada"},{"name":"Division of General Medicine Beth Israel Deaconess Medical Center  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Cram","sequence":"additional","affiliation":[{"name":"ICES  Toronto Ontario Canada"},{"name":"Department of Medicine University of Toronto  Toronto Ontario Canada"},{"name":"Department of Medicine, School of Medicine University of Maryland  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,24]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-22009-9_494"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18530"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.17606"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.2362"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1532-5415.2002.50311.x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13739"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2014.08.017"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-019-1531-0"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200108303450911"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa012337"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016184"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/hec.3630"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2017.12.009"},{"key":"e_1_2_9_15_1","first-page":"155633162412885","article-title":"Hospital Network Centralization of Primary Total Joint Arthroplasty Is Associated With Reduced Early Complication Rates but not Reduced Readmission or Reoperation Rates: A Retrospective Database Study","author":"Ricciardi B. F.","year":"2024","journal-title":"HSS Journal"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.15.1859"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2017.10.072"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0244078"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.9778\/cmajo.20180126"},{"key":"e_1_2_9_21_1","volume-title":"Quality\u2010Based Procedures: Clinical Handbook for Hip Fracture","author":"Health Quality Ontario, Ministry of Health and Long\u2010Term Care","year":"2013"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-024-02702-8"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1503\/cjs.000517"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.295.18.2141"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2024.2470"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.14538"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30058-1"},{"key":"e_1_2_9_28_1","unstructured":"National Clinical Guideline Centre \u201cThe Management of Hip Fracture in Adults \u201d2023 https:\/\/www.nice.org.uk\/guidance\/cg124."},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00068-022-02205-5"}],"container-title":["Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70002","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T14:46:17Z","timestamp":1763736377000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1475-6773.70002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,24]]},"references-count":28,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1111\/1475-6773.70002"],"URL":"https:\/\/doi.org\/10.1111\/1475-6773.70002","archive":["Portico"],"relation":{},"ISSN":["0017-9124","1475-6773"],"issn-type":[{"value":"0017-9124","type":"print"},{"value":"1475-6773","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,24]]},"assertion":[{"value":"2025-03-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70002"}}