Effects of a Geriatrician‐Led Hip Fracture Program: Improvements in Clinical and Economic Outcomes

Miura, Lisa N.; DiPiero, Albert; Homer, L. D.

doi:10.1111/j.1532-5415.2008.02069.x

Cited by 76 publications

(44 citation statements)

References 32 publications

(48 reference statements)

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“…They found that on average, the co-management hip fracture group saved $13,737 per patient with trends towards improvement in 1-year mortality. Miura et al examined the cost of implementing a geriatrician led hip fracture service in the USA and reported that it was not only cost saving but cost effective [80]. Ginsberg et al performed a cost utility analysis comparing their Sheba model of orthogeriatric management to a reactive orthogeriatric service and concluded that joint care was more cost effective providing additional quality-adjusted life years at a reduced institutional cost per patient [88].…”

Section: Effect Of Orthogeriatric Management On Long-term Functional mentioning

confidence: 98%

“…Recognising those who will benefit from slow-stream rehabilitation and those who have reached a plateau requires experience working with older people and a multidisciplinary approach. Length of stay for patients following hip fracture is often reported as an outcome measure of interest [19] because reductions in length of stay may reflect proactive care and improved clinical outcomes [80]. However, length of stay should be matched to discharge destination and pre-existing levels of independence to ensure that reduction in length of hospital stay does in fact relate to improved clinical outcomes.…”

Section: Effect Of Orthogeriatric Management On Length Of Stay In Hosmentioning

confidence: 99%

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Orthogeriatrics in the management of frail older patients with a fragility fracture

Sabharwal¹,

Wilson

2015

Osteoporos Int

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This review article examines the role of orthogeriatric management for frail older patients with a fragility fracture. The history of orthogeriatrics and its application in clinical practice around the world is reported, and an evidence-based evaluation for the effect of orthogeriatric management on patient morbidity and mortality is also provided. It has been more than 50 years since the role of the geriatrician in the management of patients with a hip fracture was first described. The evidence that supports an orthogeriatric model of care has grown exponentially over the last decade. This evidence base is primarily related to hip fractures and demonstrates reduced morbidity and mortality rates amongst patients managed with a recognised model of orthogeriatric care. The societal and economic burden of hip fracture has led to health economic evaluations within this field, many of which have concluded that orthogeriatric management results in cost-effective clinical practice. Based on existing clinical and economic research, national clinical practice guidelines have been developed in several countries which recommend orthogeriatric participation in the management of older patients with a hip fracture. Compliance with such guidance has already demonstrated improved patient outcomes. Although the pathogenesis and prognosis of other types of fragility fracture may be as poor, there is a dearth of clinical research that evaluates the effect of orthogeriatric management on such injuries. Looking to the future, orthogeriatric management is likely to become more widespread, and the robust collection and reporting of patient outcomes from national registries will provide a greater understanding of the impact of orthogeriatric models in the care of all frail older patients with any type of fragility fracture.

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Section: Effect Of Orthogeriatric Management On Long-term Functional mentioning

confidence: 98%

Section: Effect Of Orthogeriatric Management On Length Of Stay In Hosmentioning

confidence: 99%

Orthogeriatrics in the management of frail older patients with a fragility fracture

Sabharwal¹,

Wilson

2015

Osteoporos Int

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“…Some of the published papers describe co-management as the primary intervention with mixed results [8][9][10][11]. The enormity of this problem and high incidence of complications have led to the development of a comprehensive program that combines comanagement of the patient by orthopedic surgeons and geriatricians with lean business principles to create an improved model of patient care [7,12].…”

Section: Introductionmentioning

confidence: 99%

Co-managed care for fragility hip fractures (Rochester model)

2010

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Hip fractures in older adults are a common event with a high risk of morbidity and mortality. Patients who sustain a hip fracture often present with multiple co-morbid conditions that can benefit from co-management by orthopedic surgeons and geriatricians. This manuscript describes a co-managed model of care for patients with hip fractures. This model of care will be explained, and the benefits and results will be described. Retrospective review of the care of all native non-pathological hip fracture patients aged 60 years and older admitted between April 2005 and March 2009 to a 261-bed community teaching hospital. The outcome measures include patient characteristics, length of stay, mortality, 30-day readmission, re-operation, and costs of care. Seven hundred fifty-eight patients were identified with an average age of 84.8 (SD 8.4); 77.8% of the patients were female, 94.7% Caucasian, and 37.3% from nursing homes, and the mean Charlson score is 2.9 (SD 2.1). The length of stay was 4.3 days, 30-day readmission rate was 10.4%, 17-month re-operation rate was 1.9%, and costs of care to the system were $15,188. The 1-year mortality rate was 21.2%. This model of care resulted in improvements in all measures studied. Previous studies have shown reduction in in-hospital complications. Additional studies are needed to show if this model of care can be translated to other systems or to other surgical conditions. Wide application of this model care could substantially improve the quality of care and cost of caring for frail elders with hip fractures.

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“…This model of care has previously been shown to decrease length of stay (LOS), re-admission rates, complications, costs of care, and in-hospital mortality. 25,[31][32][33][34][35][36] …”

mentioning

confidence: 99%

The 1-Year Mortality of Patients Treated in a Hip Fracture Program for Elders

Schnell

Friedman

Mendelson

et al. 2010

Geriatr Orthop Surg Rehabil

366

231

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Comanagement of geriatric hip fracture patients with standardized protocols has been shown to improve short-term outcomes after surgery. A standardized, patient-centered, comanaged Hip Fracture Program for Elders is examined for 1-year mortality. Patients 60 years of age who were treated in the Hip Fracture Program for Elders were comanaged by orthopaedic surgeons and geriatricians. Data including age, place of origin, procedure, length of stay, 1-year mortality, Charlson score, and activities of daily living (ADLs) were retrospectively collected. A total of 758 patients 60 years of age with hip fractures between April 15, 2005, and March 1, 2009, were included. Their data were analyzed, and the Social Security Death Index and the hospital data system were searched for mortality data. Seventy-eight percent were female, with a mean age of 84.8 years. The mean Charlson score was 3. Fifty percent were admitted from an institutional setting. The overall 1-year mortality was 21.2%. Age (odds ratio [OR] ¼ 1.03, 95% confidence interval [CI] ¼ 1.00-1.05; P ¼ .02), male gender (OR ¼ 1.55, 95% CI ¼ 1.01-2.36; P ¼ .04), low Parker mobility score (OR ¼ 2.94, 95% CI ¼ 1.31-6.57; P ¼ .01), and a Charlson score of 4 or greater (OR ¼ 2.15, 95% CI ¼ 1.30-3.55; P ¼ .002) were predictive of 1-year mortality. ADL dependence was a borderline predictor, as was medium Parker mobility score. Prefracture residence and moderate comorbidity (Charlson score of 2-3) were not independently predictive of mortality at 1 year after adjusting for other characteristics. A comprehensive comanaged hip fracture program for elders not only improves the short-term outcomes but also demonstrates a low 1-year mortality rate, particularly in patients from nursing facilities.Keywords geriatric trauma, systems of care, fragility fractures, hip, fractures, mortality Hip fractures in older adults are a leading public health concern. The incidence of hip fractures has been declining over the past decade; however, the total number of fractures has grown exponentially. 1 The number of hip fractures in the United States could total 840 000 by the year 2040.2,3 Older adults are the fastest growing segment of the US population. The population aged 65 years and older is predicted to more than double by 2050, increasing from 39 million today to 89 million. 4 It has been estimated that 1 in 3 women and 1 in 12 men will sustain a hip fracture in their lifetime.5 It has been reported that 86% of hip fractures occur in individuals aged 65 years and older. Hip fractures are associated with significant morbidity, mortality, loss of independence, and financial burden. [6][7][8][9][10][11][12] In usual care, the reported 1-year mortality after sustaining a hip fracture has been estimated to be 14% to 58% (Table 1). 1,7,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] The relative risk of mortality in the elderly patient population increases 4% per year. 30 The first year after a hip fracture appears to be the most critical time. A recent meta-ana...

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Effects of a Geriatrician‐Led Hip Fracture Program: Improvements in Clinical and Economic Outcomes

Cited by 76 publications

References 32 publications

Orthogeriatrics in the management of frail older patients with a fragility fracture

Orthogeriatrics in the management of frail older patients with a fragility fracture

Co-managed care for fragility hip fractures (Rochester model)

The 1-Year Mortality of Patients Treated in a Hip Fracture Program for Elders

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