title: Outcomes for older patients with hip fractures: the impact of orthopedic and geriatric medicine cocare.
abstract: OBJECTIVE
  To assess the impact of a specifically designed model of orthopedic-geriatric cocare on hip fracture (HF) outcomes.
  
  
  METHODS
  Tertiary teaching hospital (level I trauma center).
  
  
  METHODS
  Prospective observational study with a retrospective (historical) control. Data on 951 consecutive patients 60 years of age or older admitted to the authors' institution with a nonpathologic HF over a 7-year period (1995 to 2002) were analyzed. Between 1995 and 1997, medical problems were managed by a geriatric medicine (GM) consultation-only service (retrospective audit). In 1998, a GM registrar began overseeing daily medical care with weekly geriatrician consultant review (prospective study). Outcomes for 2 time periods were compared: a 3-year period before (no GM; 504 patients) and a 4-year period after (GM; 447 patients) the introduction of GM cocare.
  
  
  METHODS
  Postoperative medical complications, mortality, length of stay, discharge destination, use of thromboprophylaxis, and antiosteoporotic treatment.
  
  
  RESULTS
  While comparing 2 periods (GM and no GM), significant reductions in postoperative medical complications and comorbid conditions (in total 49.5% vs. 71.0%, P<0.001) and mortality (4.7% vs. 7.7%, P<0.01) occurred and rehospitalization to medical wards within 6 months decreased (28% vs. 7.6%). However, no differences were observed in median length of hospital stay (10.8 vs. 11.0 days) or in discharge destination. Antiosteoporotic treatment (12% to 69%) and specific thromboprophylaxis (63% to 94%) increased in the GM period.
  
  
  CONCLUSIONS
  Orthopedic-geriatric cocare for the older patients with HF was associated with significant reductions in morbidity and mortality, and increases in optimal postoperative care. Options for further improvement of orthopedic-GM cocare need to be investigated.
authors.affiliation: Department of Geriatric Medicine, ACT, Australia. alex.fisher@act.gov.au
authors.forename: A A
authors.initials: AA
authors.lastname: Fisher
authors.forename: M W
authors.initials: MW
authors.lastname: Davis
authors.forename: S E
authors.initials: SE
authors.lastname: Rubenach
authors.forename: S
authors.initials: S
authors.lastname: Sivakumaran
authors.forename: P N
authors.initials: PN
authors.lastname: Smith
authors.forename: M M
authors.initials: MM
authors.lastname: Budge
mesh_terms: D000368:Aged; D001315:Australia; D019091:Critical Pathways; D003695:Delivery of Health Care; D005260:Female; D005853:Geriatrics; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009985:Orthopedics; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000517:prevention & control