title: Can improved quality of care explain the success of orthogeriatric units? A population-based cohort study.
abstract: BACKGROUND
  admission to orthogeriatric units improves clinical outcomes for patients with hip fracture; however, little is known about the underlying mechanisms.
  
  
  OBJECTIVE
  to compare quality of in-hospital care, 30-day mortality, time to surgery (TTS) and length of hospital stay (LOS) among patients with hip fracture admitted to orthogeriatric and ordinary orthopaedic units, respectively.
  
  
  METHODS
  population-based cohort study.
  
  
  METHODS
  using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry, we identified 11,461 patients aged ≥65 years admitted with a hip fracture between 1 March 2010 and 30 November 2011. The patients were divided into two groups: (i) those treated at an orthogeriatric unit, where the geriatrician is an integrated part of the multidisciplinary team, and (ii) those treated at an ordinary orthopaedic unit, where geriatric or medical consultant service are available on request. Outcome measures were the quality of care as reflected by six process performance measures, 30-day mortality, the TTS and the LOS. Data were analysed using log-binomial, linear and logistic regression controlling for potential confounders.
  
  
  RESULTS
  admittance to orthogeriatric units was associated with a higher chance for fulfilling five out of six process performance measures. Patients who were admitted to an orthogeriatric unit experienced a lower 30-day mortality (adjusted odds ratio (aOR) 0.69; 95% CI 0.54-0.88), whereas the LOS (adjusted relative time (aRT) of 1.18; 95% CI 0.92-1.52) and the TTS (aRT 1.06; 95% CI 0.89-1.26) were similar.
  
  
  CONCLUSIONS
  admittance to an orthogeriatric unit was associated with improved quality of care and lower 30-day mortality among patients with hip fracture.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Department of Orthopedic Surgery, Hospital Horsens, Horsens, Denmark.
authors.forename: Pia Kjær
authors.initials: PK
authors.lastname: Kristensen
authors.affiliation: Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Theis Muncholm
authors.initials: TM
authors.lastname: Thillemann
authors.affiliation: Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Kjeld
authors.initials: K
authors.lastname: Søballe
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Søren Paaske
authors.initials: SP
authors.lastname: Johnsen
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration / Q000592:standards*; D003718:Denmark; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000401:mortality / Q000592:standards*; D005853:Geriatrics / Q000458:organization & administration / Q000592:standards*; D006620:Hip Fractures / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D009985:Orthopedics / Q000458:organization & administration / Q000592:standards*; D010343:Patient Admission; D017064:Process Assessment, Health Care / Q000458:organization & administration / Q000592:standards*; D011446:Prospective Studies; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000458:organization & administration / Q000592:standards*; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: 30-day mortality; hip fracture; length of stay; older people; orthogeriatric; quality of care