title: Orthogeriatric care pathway: a prospective survey of impact on length of stay, mortality and institutionalisation.
abstract: BACKGROUND
  Care pathways for elderly hip fracture patients are increasingly implemented but there has been only limited evaluation of their use. Our objective was to investigate the impact of such a care pathway on the use of healthcare resources and on patients' outcomes.
  
  
  METHODS
  The prospective survey covered 493 hip fracture patients 65 years of age or older that were treated either before "Usual Care = (UC)" or after "Co-Managed-Care = (CMC)" implementation of the care pathway. Primary outcome was length of stay (LoS). Secondary outcomes were 1-year mortality and change in residential status from prefracture baseline to 1-year after surgery. Data were analysed by descriptive and interferential statistics and adjustment for baseline differences amongst the two patient groups was done.
  
  
  RESULTS
  Patients in the CMC sample had more preexisting comorbidities (CCI 2.5 versus 2.1). Prior to the fracture, a larger proportion amongst them needed help in ADL (49 versus 26%), and they were more likely to reside in a nursing home (36 versus 29%). Prefracture mobility status was equal in both samples. In the CMC sample LoS was significantly shorter (LoS 8.6 versus 11.3 days, p < 0.01) and patients were less likely to experience a complication (59 vs 73%, p < 0.01) while being in the hospital. There was no significant difference in 1-year mortality or in change of residential status.
  
  
  CONCLUSIONS
  A care pathway for elderly hip fracture patients allowed decreased LoS without affecting mortality or change of residential status 1 year after fracture compared to prefracture baseline.
authors: Traumatology, Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland, Norbert.Suhm@usb.ch.
authors: N
authors: N
authors: Suhm
authors: R
authors: R
authors: Kaelin
authors: P
authors: P
authors: Studer
authors: Q
authors: Q
authors: Wang
authors: R W
authors: RW
authors: Kressig
authors: D
authors: D
authors: Rikli
authors: M
authors: M
authors: Jakob
authors: M
authors: M
authors: Pretto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D003266:Continuity of Patient Care / Q000592:standards; D019091:Critical Pathways; D005260:Female; D005594:Fracture Fixation, Intramedullary; D019538:Health Care Surveys; D062785:Hemiarthroplasty; D006620:Hip Fractures / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011300:Preoperative Care / Q000379:methods / Q000592:standards; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012112:Residential Facilities; D016896:Treatment Outcome