title: [The acute orthogeriatric unit. Assessment of its effect on the clinical course of patients with hip fractures and an estimate of its financial impact].
abstract: OBJECTIVE
  To study the effects of the management of hip fracture patients in an acute orthogeriatric unit shared between the departments of Orthopedic Surgery and Geriatrics compared with the usual hospital care, and to analyse financial differences in both systems of care.
  
  
  METHODS
  Prospective quasy-experimental randomized intervention study in 506 patients admitted to a terciary hospital with an osteoporotic hip fracture. The usual model of care was the admission to the orthopedic ward with a request to Geriatrics (RC) and the study model consisted of the admission to an orthogeriatric unit (OGU) for the shared co-management between orthopaedic surgeons and geriatricians. This model included the appointment of one spokesperson from each department, the specialist geriatric nurse management, early geriatric assessment, shared daily clinical care, weekly joint ward round and coordinated planning of the surgery schedule, the start of the ambulation and the time and setting of patient discharge.
  
  
  RESULTS
  Two hundred fifty five consecutive patients admitted to the OGU and 251 patients managed simultaneously by the RC model were included. Except for a mean age slightly lower in the OGU group, there were no differences neither in the baseline patients characteristics nor in the surgical rates between the two groups. Among the OGU patients group it was more frequent to receive rehabilitation in the acute setting, to be able to walk at discharge and to be referred to a geriatric rehabilitation unit (all with P < .05). The OGU patients received geriatric assessment and were operated on earlier than the RC patients (P < .001). The length of stay in the acute ward was 34% shorter in the OGU patients (mean 12.48 ± 5 vs 18.9 ± 8.6 days, P < .001) (median 12 [9-14] vs 17 [13-23] days, P < .001). The whole hospital length of stay, including the days spent in the geriatric rehabilitation units, was 11% shorter in the OGU patients (mean 21.16 ± 14.7 vs 23.9 ± 13.8 days, P < 0.05) (median 14 [10-31] vs 20 [14-30] days, P < .001). The OGU saved 1,207 € to 1,633 € per patient when estimated by the costs for process model, and 3,741 € when estimated by the costs for stay model.
  
  
  CONCLUSIONS
  The OGU is a hospital setting that provides an improvement in the patients functional outcome and a reduction in the hospital length of stay. Therefore it saves health care resources. These findings show the OGU as an advisable setting for the acute care of hip fracture patients.
authors.affiliation: Servicio de Geriatría, Hospital Universitario La Paz, Universidad Autónoma de Madrid, IdiPAZ, Madrid, España. jgonzalezm.hulp@salud.madrid.org
authors.forename: Juan Ignacio
authors.initials: JI
authors.lastname: González Montalvo
authors.forename: Pilar
authors.initials: P
authors.lastname: Gotor Pérez
authors.forename: Alberto
authors.initials: A
authors.lastname: Martín Vega
authors.forename: Teresa
authors.initials: T
authors.lastname: Alarcón Alarcón
authors.forename: José Luis Mauleón
authors.initials: JL
authors.lastname: Álvarez de Linera
authors.forename: Enrique
authors.initials: E
authors.lastname: Gil Garay
authors.forename: Eduardo
authors.initials: E
authors.lastname: García Cimbrelo
authors.forename: Julián
authors.initials: J
authors.lastname: Alonso Biarge
mesh_terms: D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005260:Female; D005853:Geriatrics; D006620:Hip Fractures / Q000191:economics* / Q000601:surgery*; D006757:Hospital Units; D006801:Humans; D008297:Male; D009985:Orthopedics; D010348:Patient Care Team; D011446:Prospective Studies