 |
|
Impact of a Comanaged Geriatric Fracture Center on Short-term Hip Fracture Outcomes
Susan M. Friedman, MD, MPH;
Daniel A. Mendelson, MD, MS;
Karilee W. Bingham, RN, BS;
Stephen L. Kates, MD
Arch Intern Med. 2009;169(18):1712-1717.
Background Hip fractures are associated with substantial morbidity and mortality for older adults. Patients sustaining hip fractures usually have comorbid conditions that may benefit from comanagement by geriatricians and orthopedic surgeons.
Methods The Geriatric Fracture Center (GFC) is part of a community teaching hospital. Patients are comanaged daily by a geriatrician and orthopedic surgeon, emphasizing total quality management, timely treatment, and standardized care. We reviewed medical records to compare process and outcome measures in the GFC with a local institution that did not have a fracture management service. Patients 60 years or older admitted for a proximal femur fracture from May 1, 2005, to April 30, 2006, were included; pathological, recurrent, high-energy, periprosthetic, and nonoperative fractures were excluded.
Results Geriatric Fracture Center patients (n = 193) were significantly older, were less likely to reside in the community, and had more comorbid conditions and dementia than usual care patients (n = 121). Despite baseline differences, GFC patients, compared with usual care patients, had shorter times to surgery (24.1 vs 37.4 hours), fewer postoperative infections (2.3% vs 19.8%), fewer complications overall (30.6% vs 46.3%), and shorter length of stay (4.6 vs 8.3 days). Compared with GFC patients, physical restraint use was significantly higher in usual care patients (0% vs 14.1%). After we adjusted for baseline characteristics, patients treated in the GFC had shorter times to surgery, shorter length of stay, fewer cardiac complications, and fewer cases of thromboembolism, delirium, and infection. There was no difference in in-hospital mortality or 30-day readmission rate.
Conclusion Comanagement by geriatricians and orthopedic surgeons, combined with standardized care, leads to improved processes and outcomes for patients with hip fractures.
Author Affiliations: Departments of Medicine (Drs Friedman and Mendelson and Ms Bingham) and Orthopaedic Surgery (Dr Kates), University of Rochester School of Medicine and Dentistry, Rochester, New York.
 CiteULike  Connotea  Delicious  Digg  Facebook  Reddit  Technorati  Twitter
What's this?
RELATED LETTERS
Comanagement of Elderly Patients Admitted to a Hospital for Hip Fracture
Renzo Rozzini and Marco Trabucchi
Arch Intern Med. 2010;170(4):392-393.
EXTRACT
| FULL TEXT
Comanagement of Elderly Patients Admitted to a Hospital for Hip Fracture—Reply
Susan M. Friedman, Daniel A. Mendelson, Karilee W. Bingham, and Stephen L. Kates
Arch Intern Med. 2010;170(4):393.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
The Charlson Comorbidity Index Score as a Predictor of 30-Day Mortality After Hip Fracture Surgery
Kirkland et al.
American Journal of Medical Quality 2011;26:461-467.
ABSTRACT
Causes and Effects of Surgical Delay in Patients With Hip Fracture: A Cohort Study
Vidan et al.
ANN INTERN MED 2011;155:226-233.
ABSTRACT
| FULL TEXT
Achieving Comanagment's Potential Requires System Redesign and Hospitalist-Focused Training
Levin and Glasheen
Arch Intern Med 2011;171:1299-1299.
FULL TEXT
A Geriatric Multidisciplinary and Tailor-Made Hospital-At-Home Method in Nursing Home Residents With Hip Fracture
Gregersen et al.
Geriatric Orthopaedic Surgery & Rehabilitation 2011;2:148-154.
ABSTRACT
Pharmacologic Reversal of Warfarin-Associated Coagulopathy in Geriatric Patients With Hip Fractures: A Retrospective Study of Thromboembolic Events, Postoperative Complications, and Time to Surgery
Vitale et al.
Geriatric Orthopaedic Surgery & Rehabilitation 2011;2:128-134.
ABSTRACT
A Guide to Improving the Care of Patients With Fragility Fractures
Bukata et al.
Geriatric Orthopaedic Surgery & Rehabilitation 2011;2:5-37.
Prevention and Clinical Management of Hip Fractures in Patients With Dementia
Menzies et al.
Geriatric Orthopaedic Surgery & Rehabilitation 2010;1:63-72.
Electronic Health Records to Coordinate Decision Making for Complex Patients: What Can We Learn from Wiki?
Naik and Singh
Med Decis Making 2010;30:722-731.
ABSTRACT
The 1-Year Mortality of Patients Treated in a Hip Fracture Program for Elders
Schnell et al.
Geriatric Orthopaedic Surgery & Rehabilitation 2010;1:6-14.
Comparison of an Organized Geriatric Fracture Program to United States Government Data
Kates et al.
Geriatric Orthopaedic Surgery & Rehabilitation 2010;1:15-21.
Comanagement of Hospitalized Surgical Patients by Medicine Physicians in the United States
Sharma et al.
Arch Intern Med 2010;170:363-368.
ABSTRACT
| FULL TEXT
Comanagement of Elderly Patients Admitted to a Hospital for Hip Fracture
Rozzini and Trabucchi
Arch Intern Med 2010;170:392-393.
FULL TEXT
|
