Co-managed care for fragility hip fractures (Rochester model).
Hip fractures in older adults are a common event with a high risk of morbidity and mortality. Patients who sustain a hip fracture often present with multiple co-morbid conditions that can benefit from co-management by orthopedic surgeons and geriatricians. This manuscript describes a co-managed model of care for patients with hip fractures. This model of care will be explained, and the benefits and results will be described. Retrospective review of the care of all native non-pathological hip fracture patients aged 60 years and older admitted between April 2005 and March 2009 to a 261-bed community teaching hospital. The outcome measures include patient characteristics, length of stay, mortality, 30-day readmission, re-operation, and costs of care. Seven hundred fifty-eight patients were identified with an average age of 84.8 (SD 8.4); 77.8% of the patients were female, 94.7% Caucasian, and 37.3% from nursing homes, and the mean Charlson score is 2.9 (SD 2.1). The length of stay was 4.3 days, 30-day readmission rate was 10.4%, 17-month re-operation rate was 1.9%, and costs of care to the system were $15,188. The 1-year mortality rate was 21.2%. This model of care resulted in improvements in all measures studied. Previous studies have shown reduction in in-hospital complications. Additional studies are needed to show if this model of care can be translated to other systems or to other surgical conditions. Wide application of this model care could substantially improve the quality of care and cost of caring for frail elders with hip fractures.
Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. Stephen_kates@urmc.rochester.edu
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Friedman
D000368:Aged; D000369:Aged, 80 and over; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration*; D005260:Female; D006299:Health Services for the Aged / Q000191:economics / Q000458:organization & administration; D006620:Hip Fractures / Q000191:economics / Q000601:surgery / Q000628:therapy*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009518:New York; D058866:Osteoporotic Fractures / Q000191:economics / Q000601:surgery / Q000628:therapy*; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome