title: Barriers to implementation of an organized geriatric fracture program.
abstract: BACKGROUND
  There has been a recent increase in interest in implementing organized geriatric fracture programs for care of older adults with fragility fractures in order to improve both the quality and costs of care. Because such programs are relatively new, there are no standardized methods for implementation and no published descriptions of barriers to implementation.
  
  
  METHODS
  An online survey tool was sent to 185 surgeons and physicians practicing in the United States, who are involved with geriatric fracture care. Sixty-eight responses were received and evaluated.
  
  
  RESULTS
  Barriers identified included lack of medical and surgical leadership, need for a clinical case manager, lack of anesthesia department support, lack of hospital administration support, operating room time availability, and difficulty with cardiac clearance for surgery. Other issues important to implementation included quality improvement, cost reductions, cost to the hospital, infection prevention, readmission prevention, and dealing with competing interest groups and competing projects mandated by the government. Physicians and surgeons felt that a site visit to a functioning program was most important when considering implementing a hip fracture program.
  
  
  CONCLUSIONS
  This study provides useful insights into barriers to implementing an organized hip fracture program. The authors offer suggestions on ways to mitigate or overcome these barriers.
authors.affiliation: Department of Orthopedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Kates
authors.forename: Natasha
authors.initials: N
authors.lastname: O'Malley
authors.forename: Susan M
authors.initials: SM
authors.lastname: Friedman
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Mendelson
keywords: barriers; fragility fractures; geriatric fracture program; implementation science; orthogeriatrics; systems of care