Geriatric fracture program centering age‐friendly care associated with lower length of stay and lower direct costs

Abstract

Objective To evaluate outcomes associated with an integrated inpatient and outpatient program aimed at optimizing the care of geriatric fracture patients in a mixed community and academic health system setting. Data Sources and Study Setting This study took place at a tertiary‐care, 886‐bed hospital system. The Geriatric Fracture Program (GFP) was designed in 2018 using the 4Ms Framework (What Matters, Medication, Mentation, and Mobility). Patients ≥65 years old with non‐spine fractures managed by orthopedic faculty surgeons and participating hospitalist groups were included. A fracture liaison team educated patients regarding bone health and ensured ambulatory geriatrics follow‐up. Outpatient geriatric visits focused on mobility, fall risk, bone health imaging, and medications. Study Design We compared GFP‐enrolled patients (n = 746) to patients seen by non‐GFP‐participating physicians (n = 852) and used a generalized estimating equations approach and Poisson models to analyze associations between participation in the GFP program and four inpatient outcomes (time to surgery, length of stay, Vizient length of stay index, and total direct costs). We examined outcomes across all fractures and also stratified them by fracture type (hip vs. non‐hip). We descriptively examined post‐discharge care outcomes: fall, gait, and balance assessments; bone health imaging; and medications. Data Collection/Extraction Methods We collected data through chart reviews/electronic health record extracts from July 2018 to June 2021. Principal Findings GFP‐enrolled patients with all fracture types had a significantly lower length of stay (marginal effect [ME]: −2.12, 95%CI: −2.61, −1.63), length of stay index (ME: −0.33, 95%CI: −0.42, −0.25), and total direct costs (ME: −$5316, 95%CI: −$6806, −$3826); the magnitude of the effects was greater for non‐hip fractures. There was no significant difference in time to surgery. Of 746 GFP patients, 170 (23%) had a post‐discharge visit with a participating geriatrician ≥6 months. Conclusions A systematic approach to improving care for older adults with fractures improved length of stay and total direct costs.

Rural age‐friendly ecosystems for older adults: An international scoping review with recommendations to support age‐friendly communities

“… Positive impact on quality of life, 73,90 life satisfaction, 64,72 cognitive health, 79 physical activity, 53 civic/social participation and engagement, 27,35 perceived health, 64 and lower depression 59 and loneliness 73 Facilitates clinician identification of patient priorities, 55 family care planning, 60 and family contributions to dementia care 80 Individual well‐being 53 and social support 38 positively impacted by AFS neighborhood characteristics AFS resulted in reduced length of stay, direct costs, 32 and delirium incidence 67 …”

“… Community health, 68 sense of community, 38 and well‐being positively impacted by neighborhood characteristics, such as transportation and access to outdoor/indoor spaces 84 Built environment (housing, transportation) impact quality of life, 90 life satisfaction, and self‐perceived health 64 Exercise and recreational facilities associated with lower depression 59 Validated tool for AFS environment assessment 55,73 and community level indicators for AFS develped 53 AFS resulted in reduced length of stay and direct costs 32 Age‐friendly features associated with perceived age‐friendliness of community 46,57 AFS result in improved medication management, advanced care planning, and fall risk assessment 83 …”

“…Least common was data on outcomes of age-friendly systems in the rural ecosystem, especially at the interpersonal and organizational level. While the SWOT analysis revealed many strengths, including its impact on persons' outcomes, 27,32,45,53,59,64,67,69,79,90 and opportunities for agefriendly systems in rural areas, it also revealed several weaknesses, threats, and gaps.…”

“…Main strengths of age-friendly systems identified at the person level were the impact on individual outcomes 27,32,35,38,45,53,59,64,67,69,79,90 and incorporating patient priorities 31 and family in care. 26,52 Main strengths of age-friendly systems identified at the system level was the impact of built environment (including transportation and recreational facilities) and organizational age-friendly processes on persons' outcomes.…”

“…• AFS resulted in reduced length of stay, direct costs, 32 and delirium incidence 67 • Informal practices such as collective interdependencies and roles strengthen capacity to enhance age-friendliness 57 • Sense of community is a sustainability facilitator 81…”