Effect of Clinical Care Pathways on Quality of Life and Physical Function After Fragility Fracture: A Meta-analysis

Talevski, Jason; Sanders, Kerrie; Duque, Gustavo; Connaughton, Catherine; Beauchamp, Alison; Green, Darci; Millar, Lynne; Brennan-Olsen, Sharon

doi:10.1016/j.jamda.2019.02.022

Cited by 31 publications

(30 citation statements)

References 58 publications

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“…The orthogeriatric approach uses an important tool: The Comprehensive Geriatric Assessment (CGA). Two recent meta-analyses on the advantages of this tool in hip fractures patients showed a decrease in mortality and an improvement in activities of daily living [31], physical function and quality of life [32]. By adequately estimating perioperative risk, preventing complications and avoiding heterogeneity in the fulfilment of the goals of care; CGA leads to an important decrease of hospital stay and complications, and prioritizes the recovery of baseline functional and social status.…”

Section: Resultsmentioning

confidence: 99%

“…The implementation of orthogeriatric programs has been shown by several studies to offer greater cost-effectiveness than usual care, decreasing surgical delay, length of stay and improving physical function, with a decrease in one-year morbidity and mortality, while using fewer resources per patient and saving money [276,277], as has also been shown in systematic reviews and meta-analysis that associated orthogeriatric programs with decreases in time to surgery, LOS, complication rates and costs [32,278].…”

Section: Costsmentioning

confidence: 96%

See 1 more Smart Citation

Orthogeriatric Care: Reviewing Improvements in Outcomes

Tarazona-Santabalbina¹,

Ojeda-Thies²,

Rodríguez³

et al. 2021

Preprint

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Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Orthogeriatric co-management units have increased quality of care, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

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Section: Resultsmentioning

confidence: 99%

Section: Costsmentioning

confidence: 96%

Orthogeriatric Care: Reviewing Improvements in Outcomes

Tarazona-Santabalbina¹,

Ojeda-Thies²,

Rodríguez³

et al. 2021

Preprint

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“…There is a plethora of literature that highlights the effectiveness of paper-based clinical care pathways in hip fracture patients across multiple health outcomes [ 14 , 17 – 19 , 27 ], while studies evaluating e-pathways among hip fracture patients is limited [ 23 , 24 ]. Although paper-based care pathways have evolved and adapted with the changes with our complex and ever-changing healthcare system, they have received some criticism in terms of limitations of efficient communication between multidisciplinary teams [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…Care pathways have demonstrated to be effective in preventing common post-discharge complications (e.g. deep venous thrombosis, surgical site infection, pressure ulcers) [ 13 ]; recovery of basic activities of daily living [ 14 , 15 ] and quality of life [ 16 , 17 ]; and decreased mortality [ 18 ] and re-fracture rates [ 19 ]. However, care pathways are generally paper based, which can often cause communication failures between clinical teams, potentially causing delays in surgery and compromising patient safety [ 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of an electronic care pathway for hip fracture patients: a pilot before and after study

Talevski

Guerrero-Cedeño

Demontiero

et al. 2020

BMC Musculoskelet Disord

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Background Care pathways are generally paper-based and can cause communication failures between multidisciplinary teams, potentially compromising the safety of the patient. Computerized care pathways may facilitate better communication between clinical teams. This study aimed to investigate whether an electronic care pathway (e-pathway) reduces delays in surgery and hospital length of stay compared to a traditional paper-based care pathway (control) in hip fracture patients. Methods A single-centre evaluation with a retrospective control group was conducted in the Orthogeriatric Ward, Nepean Hospital, New South Wales, Australia. We enrolled patients aged > 65 years that were hospitalized for a hip fracture in 2008 (control group) and 2012 (e-pathway group). The e-pathway provided the essential steps in the care of patients with hip fracture, including examinations and treatment to be carried out. Main outcome measures were delay in surgery and hospital length of stay; secondary outcomes were in-hospital mortality and discharge location. Results A total of 181 patients were enrolled in the study (129 control; 54 e-pathway group). There was a significant reduction in delay to surgery in the e-pathway group compared to control group in unadjusted (OR = 0.19; CI 0.09–0.39; p < 0.001) and adjusted (OR = 0.22; CI 0.10–0.49; p < 0.001) models. There were no significant differences between groups for length of stay (median 11 vs 12 days; p = 0.567), in-hospital mortality (1 vs 7 participants; p = 0.206) or discharge location (p = 0.206). Conclusions This pilot study suggests that, compared to a paper-based care pathway, implementation of an e-pathway for hip fracture patients results in a reduction in total number of delays to surgery, but not hospital length of stay. Further evaluation is warranted using a larger cohort investigating both clinical and patient-reported outcome measures.

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“…( 12 ) These services are interdisciplinary, combining orthopedic surgery, geriatric care, primary care, and ancillary services such as physical therapy, ( 13 ) and aim to ensure patients aged ≥50 years who present to hospital with a MOF receive the appropriate evaluation and treatment for osteoporosis in accordance with clinical guidelines. ( 14 ) Clinical care pathways have shown improvements in recovery of basic activities of daily living, ( 15 ) decreased refracture rates, ( 14 ) and improved HRQoL in hip fracture patients compared to usual care ( 16 ) ; however, there is significant variability among these care pathways in terms of the healthcare and community services offered to patients.…”

Section: Introductionmentioning

confidence: 99%

Health Service Use and Quality of Life Recovery 12 Months Following Major Osteoporotic Fracture: Latent Class Analyses of the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS)

Talevski

Sanders

Busija

et al. 2020

Journal of Bone and Mineral Research

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Major osteoporotic fractures (MOFs) are associated with a rapid decline in health‐related quality of life (HRQoL); however, there is limited knowledge about which healthcare services positively affect HRQoL postfracture. This study aimed to identify specific combinations of health service use associated with recovery of HRQoL 12 months post‐MOF. The analyses included 4126 adults aged ≥50 years with an MOF (1657 hip, 1354 distal forearm, 681 vertebrae, 434 humerus) participating in the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS), a multinational observational study (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, United Kingdom, and United States). HRQoL at prefracture and 12 months postfracture was measured using the EuroQoL questionnaire (EQ‐5D‐3L). Health service use data were collected via participant interviews and medical record reviews including in‐hospital care; outpatient care; community services; and medication use. Data analyses involved two stages: (i) latent class analyses to identify different combinations of health service use (“classes”); and (ii) logistic regression to assess effects of classes on HRQoL recovery. Analyses were repeated excluding hip fractures (non‐hip MOFs). Overall, 2057 MOF participants (49.9%) recovered to their prefracture HRQoL at 12‐month follow‐up; this proportion was higher for non‐hip MOFs (n = 1439; 58.3%). Several distinct classes were identified across countries (range, 2–5 classes). Classes that were associated with increased odds of HRQoL recovery were characterized by a combination of hospital presentations without admission; outpatient department visits; allied health visits; vitamin D/calcium supplementation; and/or non‐opioid analgesic use. Similar classes were observed for non‐hip MOFs. Understanding country‐specific healthcare service pathways that influence greater recovery of HRQoL, particularly services that are uncommon in some countries and routine in others, could improve postfracture care on a global scale. © 2020 American Society for Bone and Mineral Research (ASBMR).

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Effect of Clinical Care Pathways on Quality of Life and Physical Function After Fragility Fracture: A Meta-analysis

Cited by 31 publications

References 58 publications

Orthogeriatric Care: Reviewing Improvements in Outcomes

Orthogeriatric Care: Reviewing Improvements in Outcomes

Implementation of an electronic care pathway for hip fracture patients: a pilot before and after study

Health Service Use and Quality of Life Recovery 12 Months Following Major Osteoporotic Fracture: Latent Class Analyses of the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS)

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