title: Measures of clinical outcome before, during, and after implementation of a comprehensive geriatric hip fracture program: is there a learning curve?
abstract: OBJECTIVE
  To evaluate the effects of implementing a multidisciplinary geriatric hip fracture program on clinical outcome measures at our institution.
  
  
  METHODS
  Retrospective comparative cohort study of consecutive patients treated before, during, and after implementation of this program, including patient data from electronic medical records and state death records.
  
  
  METHODS
  Single metropolitan level 2 regional trauma center and community hospital.
  
  
  METHODS
  Patients aged 60 years and older with operatively treated low-energy hip fractures were included. Patients with active cancer or a high-energy mechanism (motor vehicle crash or fall >3 ft) were excluded.
  
  
  METHODS
  Patients were divided into 1 of 3 groups: (1) those treated before our hip fracture program (July 2008-April 2009), (2) during implementation of the hip fracture program (May 2009-Feb 2010), and (3) after the hip fracture program was instituted and participation was well established (March 2010-Dec 2010).
  
  
  METHODS
  Patient demographics, injury factors, and clinical outcomes, including performance measures (eg, time to medical clearance and surgery and length of stay) and patient deaths (in-hospital, 30 days, and 1 year), were compared.
  
  
  RESULTS
  There was significant improvement in clinical performance measures, including time to surgery and length of stay during and after implementation of our geriatric hip fracture program. The in-hospital mortality rate increased during the implementation phase of this program (P = 0.04). Once established, however, the in-hospital mortality decreased to a more typical level. Thirty-day and 1-year mortality rates were not significantly different among the 3 groups.
  
  
  CONCLUSIONS
  Most clinical outcome measures improved significantly with implementation of our geriatric hip fracture program. Increased in-hospital mortality, however, was an unintended consequence seen while establishing this program and may represent a learning curve by health care providers. Patient demise in the longer term seemed to be unaffected by implementation of the program.
  
  
  METHODS
  Therapeutic level III.
authors.affiliation: *Texas Health Harris Methodist Hospital Fort Worth; Fort Worth, TX; †Orthopaedic Surgery Residency Program, John Peter Smith Hospital, Fort Worth, TX; ‡San Antonio Military Medical Center, San Antonio, TX; and §Orthopedic Specialty Associates, Fort Worth, TX.
authors.forename: Cory A
authors.initials: CA
authors.lastname: Collinge
authors.forename: Kindra
authors.initials: K
authors.lastname: McWilliam-Ross
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Beltran
authors.forename: Tara
authors.initials: T
authors.lastname: Weaver
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D006620:Hip Fractures / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000592:standards*; D063868:Patient Outcome Assessment; D015995:Prevalence; D011361:Professional Competence / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome