Comprehensive Hip Fracture Care Program: Successive Implementation in 3 Hospitals

Jackson, Kelly; Bachhuber, Mary; Bowden, Dawn E.; Etter, Katherine; Tong, C.

doi:10.1177/2151459319846057

Cited by 8 publications

(10 citation statements)

References 25 publications

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“…They found that outcomes of hospital stay (between 4.2 and 4.6 days) and total cost of the event (USD 15,188) were substantially better than those shown in other cohorts presented in the literature 11 , 14 . Another comprehensive management program implemented in three institutions in the United States also showed a hospital stay reduction from 5.6 days in 826 patients before implementation to 4.7 days in 2,069 patients after implementation 18 . These results are consistent with the trends seen in the three institutions where the program has been implemented in Colombia.…”

Section: Discussionmentioning

confidence: 94%

“…Ellos encontraron que los tiempos de estancia hospitalaria (entre 4.2 y 4.6 días) y el costo total del evento (USD 15,188) fueron sustancialmente mejores en las cohortes de la implementación respecto a otras cohortes presentadas en la literatura 11 , 14 . Otro programa de manejo integral implementado en tres instituciones en Estados Unidos mostró reducciones de tiempos de estancia desde 5.6 días en 826 pacientes antes de la implementación a 4.7 días en 2,069 pacientes después de la implementación 18 . Estos resultados son consistentes con las tendencias encontradas en las tres implementaciones reportadas para Colombia.…”

Section: Discussionunclassified

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Analysis of the experience of the geriatric fracture program in two institutions in Colombia: a reproducible model?

et al. 2021

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Background: hip fracture is the major cause of morbidity and mortality. Geriatric fracture programs promise to improve the quality of care, health outcomes and reduce costs. Objective: To describe the results related to the Geriatric fracture programs implementation in two Colombian institutions. These results could then be compared to other published experiences to assess reproducibility of the program. Methods: A retrospective descriptive study of the patients treated under the Geriatric fracture programs in two institutions in Colombia was carried out. The information of each institution was collected from the initial year of program implementation until 2018. Demographic characteristics, length of stay, hospitalization complications, readmissions and mortality were described. Consumption of healthcare resources was defined using base cases determined with local experts and costs were estimated using standard methods. Results: 475 patients were included in the Geriatric fracture programs in two institutions. We observed an increase in the number of patients during the Geriatric fracture programs. The length of stay decreased between 8.5% and 26.1% as did the proportion of total complications, with delirium having the greatest reduction. A similar situation was seen for first year mortality (from 10.9% to 4.7% in one institution and form 11.4% to 5.1% in the other), in-hospital deaths and readmissions. Estimates of costs of stay and complications showed reductions in all scenarios, varying between 22% and 68.3% depending on the sensitivity scenario. Conclusions: The present study presents the experience of two institutions that implemented the Geriatric fracture programs with increase in the number of patients treated and reductions in the time of hospital stay, the proportion of complications, readmissions, mortality, and estimated costs. These are similar between both institutions and with other published implementations. This could hint that geriatric fracture program may be implemented with reproducible results.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionunclassified

Analysis of the experience of the geriatric fracture program in two institutions in Colombia: a reproducible model?

et al. 2021

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“…190 studies underwent full-text review, and 69 studies were selected for final analysis ( Figure and eAppendix 3 in the Supplement ). 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 …”

Section: Resultsmentioning

confidence: 99%

“…190 studies underwent full-text review, and 69 studies were selected for final analysis (Figure and eAppendix 3 in the Supplement). Among the final 69 improvement programs, 49 programs significantly decreased TTS 33,35,38,41,[43][44][45][46][47][48][49][51][52][53][54]56,57,[59][60][61][62][65][66][67][68][69][70][71][72][74][75][76][79][80][81][82][85][86][87][88]91,94,96,97,99,101,103 and 20 programs 39,40,42,50,…”

Section: Included Studiesmentioning

confidence: 99%

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

et al. 2022

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IMPORTANCE Longer time to surgery (TTS) for hip fractures has been associated with higher rates of postoperative complications and mortality. Given that more than 300 000 adults are hospitalized for hip fractures in the United States each year, various improvement programs have been implemented to reduce TTS with variable results, attributed to contextual patient-and systemlevel factors. OBJECTIVETo catalog TTS improvement programs, identify their results, and categorize program strategies according to Expert Recommendations for Implementing Change (ERIC), highlighting components of successful improvement programs within their associated contexts and seeking to guide health care systems in implementing programs designed to reduce TTS. EVIDENCE REVIEW A systematic review was conducted per the Preferred Reporting Items forSystematic Reviews and Meta-analyses guideline. Three databases (MEDLINE/PubMed, EMBASE, and Cochrane Trials) were searched for studies published between 2000 and 2021 that reported on improvement programs for hip fracture TTS. Observational studies in high-income country settings, including patients with surgical, low-impact, nonpathological hip fractures aged 50 years or older, were considered for review. Improvement programs were assessed for their association with decreased TTS, and ERIC strategies were matched to improvement program components.FINDINGS Preliminary literature searches yielded 1683 articles, of which 69 articles were included for final analysis. Among the 69 improvement programs, 49 were associated with significantly decreased TTS, and 20 programs did not report significant decreases in TTS. Among 49 successful improvement programs, the 5 most common ERIC strategies were (1) assess for readiness and identify barriers and facilitators, (2) develop a formal implementation blueprint, (3) identify and prepare champions, (4) promote network weaving, and (5) develop resource-sharing agreements. CONCLUSIONS AND RELEVANCEIn this systematic review, certain components (eg, identifying barriers and facilitators to program implementation, developing a formal implementation blueprint, preparing intervention champions) are common among improvement programs that were associated with reducing TTS and may inform the approach of hospital systems developing similar programs. Other strategies had mixed results, suggesting local contextual factors (eg, operating room availability) may affect their success. To contextualize the success of a given improvement program across different clinical settings, subsequent investigation must elucidate the association between interventional success and facility-level factors influencing TTS, such as hospital census and type, teaching status, annual surgical volume, and other factors.

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“…Longer term follow-up will be needed to confirm these results, although international comparisons have shown sustained benefits after similar integrated programs of care. 21…”

Section: Discussionmentioning

confidence: 99%

Key Service Improvements After the Introduction of an Integrated Orthogeriatric Service

Murphy

Reddin

Murphy

et al. 2019

Geriatr Orthop Surg Rehabil

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Introduction: Models of orthogeriatric care have been shown to improve functional outcomes for patients after hip fractures and can improve compliance with best practice guidelines for hip fracture care. Methods: We evaluated improvements to key performance indicators in hip fracture care after implementation of a formal orthogeriatric service. Compliance with Irish Hip Fracture standards of care was reviewed, and additional outcomes such as length of stay, access to rehabilitation, and discharge destination were evaluated. Results: Improvements were observed in all of the hip fracture standards of care. Mean length of stay decreased from 19 to 15.5 days (mean difference 3.5 days; P < .05). A higher proportion of patients were admitted to rehabilitation (16.7% vs 7.9%, P < .05), and this happened in a timelier fashion (17.8 vs 24.8 days, P < .05). We found that less patients required convalescence post-hip fracture. Discussion: A standardized approach to integrated post-hip fracture care with orthogeriatrics has improved standards of care for patients. Conclusion: Introduction of orthogeriatric services has resulted in meaningful improvements in clinical outcomes for older people with hip fractures.

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Comprehensive Hip Fracture Care Program: Successive Implementation in 3 Hospitals

Cited by 8 publications

References 25 publications

Analysis of the experience of the geriatric fracture program in two institutions in Colombia: a reproducible model?

Analysis of the experience of the geriatric fracture program in two institutions in Colombia: a reproducible model?

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

Key Service Improvements After the Introduction of an Integrated Orthogeriatric Service

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