Hip fracture programs: are they effective?
Introduction
Hip fracture is a common injury in older adults that is both greatly feared and harmful. Although the incidence of hip fracture has slightly decreased, the prevalence is increasing with the aging of the population. The outcomes of hip fracture care have improved little over the past 30 years despite improvements in anticoagulation, anesthetic management, hip fracture implants, and pharmacologic advances [1]. This situation has led many physicians and surgeons caring for hip fracture patients to look for other methods to improve patient outcomes. Altering the model of care has been one such improvement attempted in many centers. Over the past 20 years, several such models have been implemented and studied. Giusti and colleagues have already published a thoughtful and detailed analysis of these models and their attributes [2]. This manuscript will evaluate the published evidence on efficacy of organized hip fracture programs to improve patient outcomes.
Section snippets
Materials and methods
The author searched PubMed (1999–present) databases of the National Library of Medicine and Google Scholar (1999–present) for appropriate articles addressing the impact of hip fracture programs. The key words, which were searched, were the terms “geriatric fracture programs”, “hip fracture programs”, and “geriatric fracture centers”. Searching of the reference lists of potentially relevant original papers was also performed. Inclusion criteria: papers written in English in peer-reviewed
Results
From the above search strategy, 1403 results were obtained. Most of the articles were excluded by title or review of the abstract as being irrelevant to this search. This left 28 manuscripts that addressed the question of efficacy of organized hip fracture programs. When several manuscripts addressed the same model at the same institution, they were condensed into one. This left 17 programs with a reasonable quality of outcome reporting to examine in this manuscript. Programs reporting results
Discussion
Elements of highly organized hip fracture programs include standardized order sets [5], use of a clinical care pathway [5], comanagement with a medical physician and orthopaedic surgeon [5], early surgery [5, 6], use of lean business principles to optimize patient care [7], early mobility with weight bearing permitted [6], and early discharge planning [5]. Additionally, incorporation of “best practices” into each aspect of care is typically done in the most complex and organized hip fracture
Conclusions
Organized hip fracture programs offer significant benefits to patients, care providers and health systems. The more complex program designs have a more profound effect on improvement in outcomes for hip fracture patients. Most programs have reported reduced length of stay, reduced in-hospital mortality rates, and reduced complications. Some programs have reported reduced costs and reduced readmission rates after implementing an organized hip fracture program.
Conflict of interest
Grant support: PCORI, AOTrauma. Consultant: Surgical Excellence.
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