Coordination pays off: a comparison of two models for organizing hip fracture care, outcomes and costs

Abstract

SUMMARYBackground and purpose With the "graying" of the population, hip fractures place an increasing burden on health systems and call for efficient forms of care. The aim was to compare two models of organizing hip fracture care at one university hospital working at two sites. The differences in organization were coordinated care provided in one of the sites and traditional care, divided between different institutions, in the other. Material and methods The study was conducted at a Swedish university hospital and included all 503 hip fracture patients, admitted during the 1-year period of February 2009 through January 2010. Patient gender, age, type of fracture, admission and discharge dates were documented. The patients were surveyed of their health-related quality of life at the time of admission and at 4 and 12 months after discharge. The costs for the inpatient care episode were estimated using three costing methods.Results The coordinated care model resulted in a shorter hospital stay and consistently lower costs. There was no difference between patient-reported quality of life. Interpretation The care of hip fracture patients coordinated by a geriatric ward throughout the whole care episode is more cost-efficient than uncoordinated where patients are transferred to other institutions for rehabilitation.

Does Health Reform Change Femoral Neck Fracture Care? A Natural Experiment in the State of Massachusetts

“…Similar factors may explain observed changes in the disposition at discharge between the 2 periods. 10,14,20 Alternatively, the significant increase in discharge to SNFs appreciated during 2008-10 may be indicative of harmonized efforts on the part of hospitals and healthcare providers to streamline the surgical treatment and rehabilitation of patients with femoral neck fractures. Similar findings have been appreciated in other works evaluating coordinated care for patients with hip fractures.…”

“…Similar findings have been appreciated in other works evaluating coordinated care for patients with hip fractures. 14 The odds of FTR and complications were the only quality measures significantly different in the period after health reform. Observed reductions in FTR are indicative of improved quality in hospital care to a certain extent.…”

“…2,3,7 In this context, we endeavored to use the Massachusetts Statewide Inpatient Dataset (SID) to explore the impact of healthcare reform on hospital processes and quality measures associated with femoral neck fracture care. As a nondiscretionary surgical condition with a sizable impact on physical and mental health, [12][13][14][15][16][17] hip fractures are an ideal tool to examine changes in the delivery of necessary orthopaedic care that may occur secondary to health reform. We hypothesized that hospital processes associated with the care of patients with femoral neck fractures, including type of surgical intervention, hospital length of stay, and disposition at discharge would be significantly altered by the implementation of healthcare reform, as would the quality of femoral neck fracture care, including mortality rates, complication rates, and the incidence of failure to rescue (FTR) and re-operations.…”

Effects of Orthogeriatric Care Models on Outcomes of Hip Fracture Patients: A Systematic Review and Meta-Analysis

“…Of the 37 included studies, only ten studies were RCTs [16][17][18][19][20][21][22][23][24][25]. Six studies were prospective cohort studies [26][27][28][29][30][31], ten were prospective cohort studies with a retrospective control [32][33][34][35][36][37][38][39][40][41], ten were retrospective cohort studies [42][43][44][45][46][47][48][49][50][51], and one study was a prospective pre-and post-intervention study [52]. Results of the Cochrane collaboration's tool for assessing risk of bias are given in Table 2.…”

“…All studies except Shyu 2008 et al [18] that reported data on 1-year mortality could be included in a meta-analysis [27,31,32,35,38,39,41,42,44,[47][48][49][50] (Fig. 5).…”