title: Improving hip fracture outcomes with integrated orthogeriatric care: a comparison between two accepted orthogeriatric models.
abstract: our orthopaedic trauma unit serves a large elderly population, admitting 400-500 hip fractures annually. A higher than expected mortality was detected amongst these patients, prompting a change in the hip fracture pathway. The aim of this study was to assess the impact of a change in orthogeriatric provision on hip fracture outcomes and care quality indicators.
  
  
  
  the hip fracture pathway was changed from a geriatric consultation service to a completely integrated service on a dedicated orthogeriatric ward. A total of 1,894 consecutive patients with hip fractures treated in the 2 years before and after this intervention were analysed.
  
  
  
  despite an increase in case complexity, the intervention resulted in a significant reduction in mean length of stay from 27.5 to 21 days (P < 0.001), a significant reduction in mean time to surgery from 41.8 to 27.2 h (P < 0.001) and a significant 22% reduction in 30-day mortality (13.2-10.3%, P = 0.04). After controlling for the effects of age, gender, American Society of Anesthesiology (ASA) Grade and abbreviated mental test score (AMTS), the effect of integrating orthogeriatric services into the hip fracture pathway significantly reduced the risk of mortality (odds ratio 0.68, P = 0.03).
  
  
  
  changing our hip fracture service from a geriatric consultation model of care to an integrated orthogeriatric model significantly improved mortality and performance indicators. This is the first study to directly compare two accepted models of orthogeriatric care in the same hospital.
authors.affiliation: Trauma and Orthopaedics, Epsom and St Helier University Hospital NHS Trust, Carshalton, Surrey SM5 1AA, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Middleton
authors.affiliation: Department of Medicine for Elderly, University College London Hospital,  London, UK.
authors.forename: Bettina
authors.initials: B
authors.lastname: Wan
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Western Sussex Hospitals NHS Trust, Worthing, West Sussex, UK.
authors.forename: Ruy
authors.initials: R
authors.lastname: da Assunçao
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D019091:Critical Pathways / Q000458:organization & administration; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000592:standards; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D015577:Geriatric Assessment; D005853:Geriatrics / Q000458:organization & administration* / Q000592:standards; D006299:Health Services for the Aged / Q000458:organization & administration* / Q000592:standards; D006620:Hip Fractures / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D061646:Operative Time; D010348:Patient Care Team / Q000458:organization & administration; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: National Hip Fracture Database; hip fracture; integrated care; multidisciplinary treatment; older people; orthogeriatric care