Time to surgery after hip fracture across Canada by timing of admission

Sobolev, Boris; Filliter, Christopher; Levy, Adrian R.; Guy, Pierre; Kuramoto, Lisa; Kim, J. D.; Dunbar, Michael J.; Morin, Suzanne N; Sutherland, Jason M.; Jaglal, Susan; Harvey, Edward J.; Beaupré, Lauren A; Chudyk, Anna M.

doi:10.1007/s00198-017-4333-4

Cited by 16 publications

(10 citation statements)

References 32 publications

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“…Patients were not considered community-dwelling if they were admitted from continuing care (i.e., long-term residential care), which included rehabilitation facilities, chronic care facilities and nursing homes. From our initial cohort of 121,507 potentially eligible patients, we excluded 7,716 patients who died in hospital after hip fracture and 1,839 patients who underwent surgery in a hospital with an annual surgical volume of less than 24 surgeries [38]. This resulted in an analytical cohort of 111,952 community-dwelling patients who were surgically treated for first hip fracture.…”

Section: Study and Patient Settingmentioning

confidence: 99%

Discharge destination following hip fracture in Canada among previously community-dwelling older adults, 2004–2012: database study

et al. 2019

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Section: Study and Patient Settingmentioning

confidence: 99%

Discharge destination following hip fracture in Canada among previously community-dwelling older adults, 2004–2012: database study

et al. 2019

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“… 20 , 21 Most studies of elderly patients with fracture have focused attention on advances in perioperative surgical and medical care through integrated geriatric co-management models or fracture liaison services. 7 , 22 , 23 These geriatric orthopedic co-management and bone health strategies have been shown to decrease hospital length of stay, decrease surgical complications, improve in-hospital mortality, and facilitate appropriate osteoporosis management. 17 , 24 Little attention, however, has been focused on the impact of clinical interventions provided outside the hospital setting (and not specifically devoted to bone health), such as during the postacute phase of orthopedic care and beyond.…”

Section: Discussionmentioning

confidence: 99%

Mobile Outreach: An Innovative Program for Older Orthopedic Patients in Care Facilities

Switzer

Schroder

2019

Geriatr Orthop Surg Rehabil

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Introduction:The worldwide incidence of fragility fractures is increasing and the greatest burden is borne by the oldest population. Mobile Outreach, an innovative orthopedic-based program providing on-site musculoskeletal care for individuals in nursing care facilities, was implemented as part of our Geriatric Orthopaedic Trauma Program. The objectives of this report are to describe characteristics of patients cared for through Mobile Outreach and to report specific services provided.Program Description:Based from a nonprofit, private hospital that serves as the community’s level 1 trauma center and teaching hospital, the Mobile Outreach Program is directed by an orthopedic surgeon with geriatric subspecialization and staffed by a full-time geriatric nurse practitioner. Patients receive care for musculoskeletal concerns and fracture assessments at their nursing care facilities by a Mobile Outreach care provider. Referral for care is from nursing care facilities or as scheduled postoperative follow-up.Results:In 2016, the program treated 458 patients (76% female) in the patients’ care settings for a total of 689 visits. The mean age was 81 years (standard deviation = 14; range 25-107). Care of patients included nonoperative fracture care in 100 (22%), postoperative fracture follow-up in 149 (33%), injections for pain management in 184 (40%), and other orthopedic care in 25 (5%). Visits occurred at 88 facilities, mean 7 visits per site (range 1-57).Conclusions:Mobile Outreach was implemented to improve postoperative fracture care in the elderly patients. The program also provides on-site nonoperative fracture care and care of frail elderly individuals with chronic musculoskeletal conditions. This report aims to establish the feasibility of a program focused on the provision of appropriate, coordinated care for older fracture patients in their care facility. Level of Evidence: Level V.

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“…In addition, there is a lower density of physicians, in Montreal, compared to New York (Table 1). Many studies have noted the long waits for elective hospital services in Québec, as well as in Montreal (Barua and Ren, 2016; Canadian Institute for Health Information, 2017; Hajizadeh, 2017; Hwang et al ., 2017; Sheehan et al ., 2017). Although Québec has a higher density of GPs than the rest of Canada, one response to the problem of waiting times for hospital-based services has been to introduce a system – Activités Médicales Particuliers – that requires physicians to allocate a portion of their time to hospital activities.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of health system performance in Montreal and New York: the importance of context for interpreting indicators

Gusmano¹,

Strumpf

Fiset-Laniel

et al. 2018

HEPL

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Although eliminating financial barriers to care is a necessary condition for improving access to health services, it is not sufficient. Given the contrasting health systems with regard to financing and organization of health insurance in the United States and Canada, there is a long history of comparing these countries. We extend the empirical studies on the Canadian and US health systems by comparing access to ambulatory care as measured by hospitalization rates for ambulatory care sensitive conditions (ACSC) in Montreal and New York City. We find that, in New York, ACSC rates were more than twice as high (12.6 per 1000 population) as in Montreal (4.8 per 1000 population). After controlling for age, sex, and number of diagnoses, significant differences in ACSC rates are present in both cities, but are more pronounced in New York. Our findings are consistent with the hypothesis that universal, first-dollar health insurance coverage has contributed to lower ACSC rates in Montreal than New York. However, Montreal's surprisingly low ACSC rate calls for further research.

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Time to surgery after hip fracture across Canada by timing of admission

Cited by 16 publications

References 32 publications

Discharge destination following hip fracture in Canada among previously community-dwelling older adults, 2004–2012: database study

Discharge destination following hip fracture in Canada among previously community-dwelling older adults, 2004–2012: database study

Mobile Outreach: An Innovative Program for Older Orthopedic Patients in Care Facilities

Comparative analysis of health system performance in Montreal and New York: the importance of context for interpreting indicators

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