Impact of a Comanaged Geriatric Fracture Center on Short-term Hip Fracture Outcomes

Friedman, Susan M.

doi:10.1001/archinternmed.2009.321

Cited by 364 publications

(289 citation statements)

References 30 publications

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“…Also, the comanaged fracture care model has been shown by several studies to decrease postoperative complications, inpatient mortality, and ICU bed-days. 14,20,21,30 Table 5 describes techniques used to reduce costs associated with LOS, complications, and comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Comparison of an Organized Geriatric Fracture Program to United States Government Data

Kates

Blake

Bingham

et al. 2010

Geriatr Orthop Surg Rehabil

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Objective: This study describes the financial impact of an organized hip fracture program for elderly patients age 65 years and older. Methods: This is a retrospective study of 797 fractures in 776 consecutive patients over a 50-month period (May 2005 to July 2009) treated in an organized hip fracture program for the elderly identified from a quality management database. Financial, demographic, and quality-of-care data were collected. The length of hospital stay, in-hospital complications, and Charlson comorbidity scores were collected from patient records, and all data were evaluated using standard statistical methods. Setting: 261-bed community-based, university-affiliated teaching hospital in an urban setting with a catchment area of approximately 1 million persons. This is a level 3 trauma center. Results: The average total net revenue per hip fracture was $12 159, with an average total cost to hospital of $8264. Physicians' fees consisted of fees collected by surgeons, anesthesiologists, medical specialty consultants, and consulting geriatricians and averaged $2024 per case. Thus, the average hospital charge to payers was $15 188. Compared to Agency for Healthcare Research and Quality average inpatient hospital costs in 2005 of $33 693, a savings of more than $18 000 was realized per patient. The average length of stay was 4.6 days, markedly less than the national average of 6.2 days. Conclusions: This organized geriatric fracture care model with geriatrics comanagement resulted in significant cost savings over a 50-month period, with associated increased quality. With an estimated 330 000 hip fractures annually in the United States, a large cost savings could potentially be realized if this model were more widely applied.

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Section: Discussionmentioning

confidence: 99%

Comparison of an Organized Geriatric Fracture Program to United States Government Data

Kates

Blake

Bingham

et al. 2010

Geriatr Orthop Surg Rehabil

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“…The increased LOS was unexpected as most previous studies indicate a reduction by CGC. (96,200,201,203), but also the Oslo Orthogeriatric Trial had longer mean LOS in CGC. (48) An orthogeriatric consultation study from Canada (Table 1a) also reported increased LOS, but found no difference in overall time in institutions including rehabilitation after 6 months.…”

Section: Use Of Health Care Servicesmentioning

confidence: 97%

Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial

et al. 2015

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Bakgrunn: Hoftebrudd er en viktig årsak til sykdom og død med 1.3 millioner brudd årlig i verden og en fortsatt stigende insidens. Risikofaktorer er høy alder, osteoporose og skrøpelighet, og de fleste bruddene skyldes lav energitraumer på grunn av fall. Høy alder, nedsatt funksjon før bruddet og mannlig kjønn øker risiko for et uheldig resultat, mens fall utendørs er prognostisk gunstig.Utvikling av såkalt ortogeriatriske behandlingsmodeller for hoftebrudd som bruker teknikker og prinsipper utviklet i geriatrien er en måte å bedre prognosen for pasientene. Det er utviklet flere modeller:1. Konsultasjonsmodeller der pasienten på vanlig måte behandles i en ortopedisk avdeling, men får tilsyn og vurdering av geriater eller et geriatrisk team under oppholdet, og der teamet deretter foreslår tiltak til ortoped. 2. Modeller med felles ansvar der geriater og ortoped inngår i et team som utreder og behandler pasienten og legger en felles plan for videre oppfølging. 3. Geriatrisk team modeller der utredning og behandling (med unntak av selve kirurgien)foregår i en geriatrisk avdeling tilpasset bruddbehandling, og der ortopeder ansvarlig for operasjon, men ellers kun konsulteres ved behov. Målsetninger for studien: Overordnet mål for studien var å undersøke om bred geriatrisk utredning og behandling (CGC) ga en tilleggsgevinst sammenlignet med tradisjonell ortopedisk behandling (OC).Målsetninger for denne avhandlingen er:1. Å beskrive bakgrunn, utvikling og prinsippene bak de orthogeriatriske modellen og hvordan den skiller seg fra vanlig behandling (Artikkel I). 2. Å presentere kliniske resultat (Artikkel II): a. Mobilitet fire måneder etter bruddet (primaert endepunkt) b. Sekundaere endepunkt: i. Mobilitet etter en og 12 måneder, og p-i-ADL, kognisjon, frykt for å falle, stemningsleie og livskvalitet en, fire og 12 måneder etter bruddet, ii. Bruk av helsetjenester første året etter bruddet 3. Finne ut om effekten på mobilitet, p-og-i-ADL og kognisjon var avhengig av alder, kjønn, bruddtype og funksjon før bruddet (Artikkel III).Metode: Hoftebruddsstudien i Trondheim er en randomisert kontrollert studie basert på ortogeriatrimodell 3 ovenfor. Studien sammenligner standard ortopedisk behandling (OC) med ortogeriatrisk behandling i en egen enhet (CGC). Hjemmeboende pasienter 70 år eller eldre som klarer å gå minst 10m og som har et lavenergibrudd kunne inkluderes, mens pasienter fra sykehjem, høy-energi brudd, patologisk fraktur eller annen sykdom med forventede leveutsikter på mindre enn 3 måneder ble ekskludert. Behandlingen er basert på bred geriatrisk utredning (CGA) og gjennomføres av et tverrfaglig team bestående av geriater (overlege eller lege i spesialisering), sykepleier, fysioterapeut og ergoterapeut; teamet har regelmessige møter der det lages individuelle behandlingsplaner og settes mål for opphold og klargjør videre behov etter utreise samt behandlingsmål. Behandlingen er helhetlig og fokuserer på tidlig mobilisering, gjennomgang av den enkelte pasient med tanke på bakenforliggende sykdom, medisingjennomgang...

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“…Outcomes are often compromised by adverse medical events occurring during and immediately after the index hospitalization for hip fracture care [19]. Adoption of a geriatric hip fracture center offers the opportunity to standardize care processes and work in an organized manner to reduce errors and waste in the care system [13]. For older adults, minor errors in care often have catastrophic consequences.…”

Section: University Of Rochester Medical Centermentioning

confidence: 99%

“…Many studies have evaluated the impact of an early multidisciplinary intervention had on length of stay, morbidity, mortality and function after hip fracture in patients older than 65 years [1,2,12,13,20,23]. These authors have demonstrated that for patients whose care was organized and administered by a multidisciplinary geriatric intervention group there was less inpatient mortality, fewer major complications, and a shorter hospital stay.…”

Section: University Of Rochester Medical Centermentioning

confidence: 99%

Not the Last Word: Geriatric Hip Fracture Centers: The Time Has Come

Bernstein

2015

Clinical Orthopaedics &Amp; Related Research

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Impact of a Comanaged Geriatric Fracture Center on Short-term Hip Fracture Outcomes

Abstract: Comanagement by geriatricians and orthopedic surgeons, combined with standardized care, leads to improved processes and outcomes for patients with hip fractures.

Cited by 364 publications

References 30 publications

Comparison of an Organized Geriatric Fracture Program to United States Government Data

Comparison of an Organized Geriatric Fracture Program to United States Government Data

Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial

Not the Last Word: Geriatric Hip Fracture Centers: The Time Has Come

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