Clinical effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: population-based longitudinal study

Abstract

Objectives: to evaluate orthogeriatric and nurse-led fracture liaison service (FLS) models of post-hip fracture care in terms of impact on mortality (30 days and 1 year) and second hip fracture (2 years).Setting: Hospital Episode Statistics database linked to Office for National Statistics mortality records for 11 acute hospitals in a region of England.Population: patients aged over 60 years admitted for a primary hip fracture from 2003 to 2013.Methods: each hospital was analysed separately and acted as its own control in a before–after time-series design in which the appointment of an orthogeriatrician or set-up/expansion of an FLS was evaluated. Multivariable Cox regression (mortality) and competing risk survival models (second hip fracture) were used. Fixed effects meta-analysis was used to pool estimates of impact for interventions of the same type.Results: of 33,152 primary hip fracture patients, 1,288 sustained a second hip fracture within 2 years (age and sex standardised proportion of 4.2%). 3,033 primary hip fracture patients died within 30 days and 9,662 died within 1 year (age and sex standardised proportion of 9.5% and 29.8%, respectively). The estimated impact of introducing an orthogeriatrician on 30-day and 1-year mortality was hazard ratio (HR) = 0.73 (95% CI: 0.65–0.82) and HR = 0.81 (CI: 0.75–0.87), respectively. Following an FLS, these associations were as follows: HR = 0.80 (95% CI: 0.71–0.91) and HR = 0.84 (0.77–0.93). There was no significant impact on time to second hip fracture.Conclusions: the introduction and/or expansion of orthogeriatric and FLS models of post-hip fracture care has a beneficial effect on subsequent mortality. No evidence for a reduction in second hip fracture rate was found.

The association between the day of the week of milestones in the care pathway of patients with hip fracture and 30-day mortality: findings from a prospective national registry – The National Hip Fracture Database of England and Wales

“…There may be an association with the resources available at different times, for example, the provision of orthogeriatrician-led post-hip fracture care has been shown to reduce mortality and this service is not universally available at the weekend [31]. However, in the short/medium term following surgery, the risk of death at the weekend is lower compared to that of weekdays, which suggests care on the ward is likely to be at least equivalent to the care received during the week.…”

Cost-Effectiveness of Orthogeriatric and Fracture Liaison Service Models of Care for Hip Fracture Patients: A Population-Based Study

“…These models of care reflect the services provided in one regional area in the UK that comprises 11 hospitals receiving patients with acute hip fractures. Details on the OG and FLS models delivered within the region from 2003 to 2013 have been published elsewhere . Briefly, although there was variation across hospitals, the introduction of the OG model involved the appointment of an orthogeriatrician as the clinical lead, responsible for case finding, preoperative assessment, patient assessment, and treatment initiation, as well as having involvement in postoperative care.…”

Fracture liaison services: improving outcomes for patients with osteoporosis

“…Over 2 years of follow-up, a Type A FLS demonstrated a 35% reduction in mortality following a fragility fracture compared with a comparable cohort not assessed by FLS (HR 0.65, 95% CI 0.53–0.79) 41. A large cohort study in the UK using hospital admission data from 11 hospitals also reported a reduction in 30-day mortality by 20% (HR 0.80, 95% CI 0.71–0.91) and 1-year mortality by 16% (HR 0.84, 95% CI 0.77–0.93) in patients admitted to hospital after a hip fracture 44. This data set included hospitals with a newly implemented orthogeriatric service and an FLS program.…”