Effects of a Hospitalist Model on Elderly Patients With Hip Fracture

Phy, Michael; Vanness, David J.; Melton, L. Joseph; Long, Kirsten Hall; Schleck, Cathy D.; Larson, Dirk R.; Huddleston, P.M.; Huddleston, Jeanne M.

doi:10.1001/archinte.165.7.796

Cited by 187 publications

(163 citation statements)

References 18 publications

(11 reference statements)

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“…Because of the complex medical demands of these patients, some centers have evaluated the use of a dedicated multidisciplinary service where patients with hip fractures are comanaged by an orthopaedic surgeon along with a dedicated internal medicine physician (often referred to as a hospitalist) [22,24,39,52] during their acute hospitalizations. This model of care also is called ''multidisciplinary care'' or ''comprehensive geriatric care''.…”

Section: Introductionmentioning

confidence: 99%

“…Of the more successful models, two of the common features are (1) a shift in focus where both physicians act as a patient's primary caregiver as opposed to the traditional model of admission to a single service with the other service acting as a consultant, and (2) a shared goal that common medical and surgical complications should be anticipated rather than treated after their occurrence. This approach has decreased complication rates [5,17,22,45,64], time from injury until the operating room [4,24,52], hospital length of stay [5,17,24,28,39,40,52,70], and has improved osteoporosis treatment [22,28].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis

Swart

Vasudeva

Makhni

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Osteoporotic hip fractures are common injuries typically occurring in patients who are older and medically frail. Studies have suggested that creation of a multidisciplinary team including orthopaedic surgeons, internal medicine physicians, social workers, and specialized physical therapists, to comanage these patients can decrease complication rates, improve time to surgery, and reduce hospital length of stay; however, they have yet to achieve widespread implementation, partly owing to concerns regarding resource requirements necessary for a comanagement program. Questions/Purposes We performed an economic analysis to determine whether implementation of a comanagement model of care for geriatric patients with osteoporotic hip fractures would be a cost-effective intervention at hospitals with moderate volume. We also calculated what annual volume of cases would be needed for a comanagement program to ''break even'', and finally we evaluated whether universal or risk-stratified comanagement was more cost effective. Methods Decision analysis techniques were used to model the effect of implementing a systems-based strategy to improve inpatient perioperative care. Costs were obtained from best-available literature and included salary to support personnel and resources to expedite time to the operating room. The major economic benefit was decreased initial hospital length of stay, which was determined via literature review and meta-analysis, and a health benefit was improvement in perioperative mortality owing to expedited preoperative evaluation based on previously conducted meta-analyses. A break-even analysis was conducted to determine the annual case volume necessary for comanagement to be either (1) cost effective (improve health-related quality of life enough to be worth additional expenses) or (2) result in cost savings (actually result in decreased total expenses). This calculation assumed the scenario in which a hospital could hire only one hospitalist (and therapist and social worker) on a full-time basis. Additionally, we evaluated the scenario where the necessary staff was already employed at the hospital and could be dedicated to a comanagement service on a part-time basis, and explored the effect of triaging only patients considered high risk to a comanagement service versus comanaging all geriatric patients. Finally, probabilistic sensitivity analysis was conducted on all critical variables, with broad ranges used for values around which there was higher uncertainty. Results For the base case, universal comanagement was more cost effective than traditional care and risk-stratified comanagement (incremental cost effectiveness ratios of All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis

Swart

Vasudeva

Makhni

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Huddleston demostró una reducción en las complicaciones post operatorias en pacientes ortopédicos manejados por hospitalistas (p < 0,01) 41 . Phy y Roy encontraron que pacientes ortopédicos co-manejados por hospitalistas tuvieron una latencia menor a cirugía (p < 0,001 y p = 0,004) 42,43 , y estadías hospitalarias más cortas que los pacientes manejados sin hospitalistas (p < 0,001) 42 .…”

Section: Manejo Peri-operatoriounclassified

Medicina hospitalaria a 15 años de su implementación: ¿Cuáles son los potenciales beneficios en nuestro medio?

Eymin

Jaffer

2013

Rev. méd. Chile

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L a medicina hospitalaria es una disciplina dedicada a entregar cuidados médicos exhaustivos a pacientes hospitalizados, a la vez que se encarga de la docencia clínica, investigación y liderazgo en el campo de la medicina interna. A diferencia del internista general, el hospitalista brinda una atención completa y oportuna de todas las necesidades del paciente, incluyendo diagnóstico, tratamiento y procedimientos de variada índole, incorpora técnicas de mejoramiento de procesos y de calidad, colabora, comunica y coordina los cuidados prestados por los diferentes profesionales de la salud, hace uso eficiente de los recursos hospitalarios y se encarga de que las transiciones del paciente a través del hospital y entre este y su domicilio sea segura 1 . Sus competencias son variadas, y se pueden agrupar en condiciones clínicas, procedimientos y en los sistemas al interior del hospital (seguridad de pacientes, docencia, mejoría de procesos). Esta especialidad, descrita en Estados Unidos de Norteamérica en 1996, ha alcanzado un desarrollo y crecimiento sin precedentes en ese país, superando el crecimiento de todas las especialidades de la medicina 2-4 , crecimiento que coincide con el cambio en la forma de reembolso de las prestaciones médicas 5 , y con el creciente aumento del interés por mejorar la seguridad en los hospitales después de la publicación "To err is human" (1999) en la cual se describe que entre 44.000 y 98.000 personas mueren cada año en Estados Unidos de Norteamérica producto de eventos adversos potencialmente prevenibles 6 . Antiguamente el pago de prestaciones de salud en Estados Unidos de Norteamérica se hacía por servicios prestados (Fee for service), sin embargo, actualmente se hace en relación a un determinado grupo de diagnósticos relacionados, en el cual todas las condiciones codificadas bajo un mismo grupo son reembolsadas con un monto fijo independientemente del curso hospitalario del paciente 7 . Así, si los hospitales acortan las estadías y realizan menos exámenes, el ahorro para el hospital es mayor. Además, a partir del 2010 el CMS (Entidad pagadora de prestaciones en salud) comenzó a negar el reembolso asociado a reingresos a 30 días en pacientes con neumonía, insuficiencia cardiaca,

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“…Hospitalist management of hip fracture patients decreases time to surgery and LOS compared to standard care. [22][23][24] Phy and colleagues studied 466 patients for 2 years after the inception of hospital medicine comanagement of surgical patients, and found that care by hospitalists decreased LOS by 2.2 days. 22 In a retrospective study of 118 patients, Roy and colleagues found that hospitalist-managed patients had shorter time to consultation and surgery, decreased LOS, and lower costs.…”

Section: Surgical Comanagementmentioning

confidence: 99%

“…[22][23][24] Phy and colleagues studied 466 patients for 2 years after the inception of hospital medicine comanagement of surgical patients, and found that care by hospitalists decreased LOS by 2.2 days. 22 In a retrospective study of 118 patients, Roy and colleagues found that hospitalist-managed patients had shorter time to consultation and surgery, decreased LOS, and lower costs. 23 In a retrospective cohort study, Batsis looked at mortality in 466 patients with hip fracture, and found no difference between hospitalist management and standard care.…”

Section: Surgical Comanagementmentioning

confidence: 99%

Evolving practice of hospital medicine and its impact on hospital throughput and efficiencies

Chadaga

Maher

Maller³

et al. 2012

Journal of Hospital Medicine

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Hospitalists are uniquely positioned to implement strategies to improve patient flow and efficiency. Hospital leaders have stated they expect hospitalists to comanage surgical patients, participate in observation units, and screen medical admissions, in addition to providing inpatient care for medical patients. We review how the hospitalists' role in acute inpatient care, surgical comanagement, short stay units, chest pain units, and active bed management has improved throughput and patient flow. Journal of Hospital Medicine 2012. © 2012 Society of Hospital Medicine

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Effects of a Hospitalist Model on Elderly Patients With Hip Fracture

Abstract: In elderly patients with hip fracture, a hospitalist model decreased time to surgery, time from surgery to dismissal, and length of stay without adversely affecting inpatient deaths or 30-day readmission rates.

Cited by 187 publications

References 18 publications

Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis

Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis

Medicina hospitalaria a 15 años de su implementación: ¿Cuáles son los potenciales beneficios en nuestro medio?

Evolving practice of hospital medicine and its impact on hospital throughput and efficiencies

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