title: Rural collaborative guideline implementation: Evaluation of a hub and spoke multidisciplinary team model of care for orthogeriatric inpatients - A before and after study of adherence to clinical practice guidelines.
abstract: OBJECTIVE
  To evaluate whether adherence to orthogeriatric inpatient clinical practice guidelines increased after the implementation of an innovative hub and spoke multidisciplinary team, the Sub-Acute Care Team (SCT).
  
  
  METHODS
  This study used a before and after design and describes a medical record audit.
  
  
  METHODS
  Rural inpatient facilities with 20-50 inpatient beds.
  
  
  METHODS
  Inpatients aged 65 years and older who sustained a lower limb fracture from a fall were admitted to a regional facility and subsequent rural facility. The audit included 42 inpatients admitted before the SCT (April 2009-April 2010) and 35 inpatients admitted after the SCT (April 2011-April 2012).
  
  
  METHODS
  The SCT used interprofessional collaborative practice and orthogeriatric clinical practice guidelines to inform inpatient care.
  
  
  METHODS
  Adherence was measured by answering 10 questions representative of the guidelines. Chi-square or Fisher's exact tests were used for each question to identify if the proportion of inpatients receiving guideline-based care changed significantly after SCT implementation.
  
  
  RESULTS
  After SCT implementation, an increase in the adherence to guidelines was statistically significant (P < 0.05) for handover, nutrition support, falls prevention, bladder management and more than five guideline-based care questions.
  
  
  CONCLUSIONS
  Adherence to orthogeriatric inpatient clinical practice guidelines increased after the implementation of the SCT. The mechanisms likely to have contributed include the comprehensive multidisciplinary handover and the opportunity for rural inpatient clinical follow-up. This model is likely to be effective in improving care for other frail rural inpatient populations.
authors.affiliation: Western New South Wales Local Health District, Orange, New South Wales, Australia.
authors.forename: Tracey
authors.initials: T
authors.lastname: Drabsch
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D003299:Cooperative Behavior; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017146:Models, Organizational; D010348:Patient Care Team / Q000458:organization & administration*; D019035:Rural Health Services / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data
keywords: clinical practice guidelines; interprofessional; models of care; multidisciplinary; orthogeriatric