A unique orthogeriatric model: A step forward in improving the quality of care for hip fracture patients

Bhattacharyya, Rahul; Agrawal, Yuvraj; Elphick, Heather L.; Blundell, Chris

doi:10.1016/j.ijsu.2013.09.018

Cited by 13 publications

(5 citation statements)

References 11 publications

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“…Given the multitude of different implant studies which have shown little difference in one-year outcomes for this common yet socially-disruptive injury, studies like this one suggest that the patient care that takes place outside the operating room may ultimately have the biggest impact on improved outcomes. The biggest improvements thus far in hip fracture care have not come from changes in implant technology (e.g., switching to a locked side plate or to an intramedullary device) [30], but from multidisciplinary management of these patients in the acute setting; longer-term benefits of these in-hospital interventions, however, have not been widely demonstrated [32-34]. It is our hope that the current study provides new evidence regarding important patient outcomes and costs, comparing an intrinsic control group with an experimental group, and that future work will support compelling arguments to government and private payors that the most cost-effective standard of care also gives the highest quality outcome.…”

Section: Discussionmentioning

confidence: 99%

Reducing mortality in hip fracture patients using a perioperative approach and “Patient- Centered Medical Home” model: a prospective cohort study

Graham¹,

Bowen

Strohecker

et al. 2014

Patient Saf Surg

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BackgroundHip fracture patients experience high morbidity and mortality rates in the first post-operative year after discharge. We compared mortality, utilization, costs, pain and function between two prospective cohorts of hip fracture patients, both managed with identical perioperative protocols and one group subsequently managed via a “Patient-Centered Medical Home” (PCMH) primary care management model.MethodsWe analyzed 6 and 12-month outcomes from two matched cohorts of patients who were surgically treated for hip fracture from January 1, 2010 to June 30, 2011 at two hospitals (n = 194). Controls did not receive PCMH and were matched to cases on surgery date, sex, age, and comorbidities. Mortality and healthcare utilization were the primary outcomes studied, with medical costs, quality of life, pain and function at 12 months assessed as secondary outcomes in a subgroup. Survival analysis, regression and Student-t testing were used with p < 0.05 considered significant.ResultsAt 6 months, PCMH patients had significantly lower mortality than patients receiving standard care (11% vs. 26%, p < 0.01). At 12 months, a difference persisted (23% vs. 30%, p = 0.12) but was no longer statistically significant. Mean quality of life scores were similar (0.73 vs. 0.76, p = 0.49) and Harris Hip score was slightly improved for PCMH (73 vs. 64, p = 0.04). Mean costs per patient per month were lower for PCMH but not significantly different ($69 vs. $141, p = 0.20 for pharmacy costs; $1212 vs. $1452, p = 0.45 for non-pharmacy costs).ConclusionsPatients receiving aggressive post-discharge care from a PCMH program showed significant benefits in terms of reduced mortality at 6 months, with similar costs and functional outcomes at 12 months. PCMH was not shown to improve all outcomes studied, but these results suggest that ongoing Medical Home management can have some benefit for patients without negatively impacting function or cost.

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Section: Discussionmentioning

confidence: 99%

Reducing mortality in hip fracture patients using a perioperative approach and “Patient- Centered Medical Home” model: a prospective cohort study

Graham¹,

Bowen

Strohecker

et al. 2014

Patient Saf Surg

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“…Different studies 103 – 115 have confirmed that the orthogeriatric care model reduces mean stay and mortality. An analysis 116 divided the patients with hip fracture into two age groups (65–84 versus ≥85 years).…”

Section: Resultsmentioning

confidence: 93%

Orthogeriatric care: improving patient outcomes

Tarazona-Santabalbina¹,

Belenguer-Varea²,

Rovira³

et al. 2016

CIA

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Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard.

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“…The model designed aimed to contribute comprehensive and early care, emphasising urgency in geriatric valuation, surgery, and the early beginning of the rehabilitation process in order to recover mobility in the shortest time possible after surgery [20,37,38,39,40,41,42].…”

Section: Methodsmentioning

confidence: 99%

Estimate of the Costs Caused by Adverse Effects in Hospitalised Patients Due to Hip Fracture: Design of the Study and Preliminary Results

Cuesta-Peredó

Tarazona-Santabalbina

Borras-Mañez

et al. 2018

Geriatrics

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Introduction: Hip fracture is a health problem that presents high morbidity and mortality, negatively influencing the patient’s quality of life and generating high costs. Structured analysis of quality indicators can facilitate decision-making, cost minimization, and improvement of the quality of care. Methods: We studied 1571 patients aged 70 years and over with the diagnosis of hip fracture at Hospital Universitario de la Ribera in the period between 1 January 2012 and 31 December 2016. Demographic, clinical, functional, and quality indicator variables were studied. An indirect analysis of the costs associated with adverse events arising during hospital admission was made. A tool based on the “Minimum Basic Data Set (CMBD)” was designed to monitor the influence of patient risk factors on the incidence of adverse effects (AE) and their associated costs. Results: The average age of the patients analysed was 84.15 years (SD 6.28), with a length of stay of 8.01 days (SD 3.32), a mean preoperative stay of 43.04 h (SD 30.81), and a mortality rate of 4.2%. Likewise, the percentage of patients with AE was 41.44%, and 11.01% of patients changed their cost as a consequence of these AEs suffered during hospital admission. The average cost of patients was €8752 (SD: 1,864) and the average cost increase in patients with adverse events was €2321 (SD: 3,164). Conclusions: Through the analysis of the main clinical characteristics and the indirect estimation of the complexity of the patients, a simple calculation of the average cost of the attention and its adverse events can be designed in patients who are admitted due to hip fracture. Additionally, this tool can fit the welfare quality indicators by severity and cost.

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A unique orthogeriatric model: A step forward in improving the quality of care for hip fracture patients

Abstract: This unique model improved care for hip fracture patients and was cost effective. Furthermore, it highlighted excellent staff satisfaction. This can pioneer a change in the management of hip fracture patients nationally and internationally.

Cited by 13 publications

References 11 publications

Reducing mortality in hip fracture patients using a perioperative approach and “Patient- Centered Medical Home” model: a prospective cohort study

Reducing mortality in hip fracture patients using a perioperative approach and “Patient- Centered Medical Home” model: a prospective cohort study

Orthogeriatric care: improving patient outcomes

Estimate of the Costs Caused by Adverse Effects in Hospitalised Patients Due to Hip Fracture: Design of the Study and Preliminary Results

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