title: Using a Comanagement Model to Develop a Hip Fracture Integrated Care Pathway.
abstract: Hip fracture care represents a service line that profoundly affects patients' quality of life. As hospitals and physicians are motivated to improve quality, reduce costs, and maximize efficiency of care, several alignment models have been proposed under new healthcare legislation. Evaluation of such models as they pertain to hip fracture care warrants further investigation. In this article, we identify the current model of operations present in large healthcare organizations, examine the reasoning behind hospital-physician alignment, and describe specific comanagement principles that are common in healthcare settings. Furthermore, the effects of a comanagement model on a hip fracture integrated care pathway will be demonstrated through a case study. A comanagement team was formed at a Level I academic trauma center to create an integrated care pathway for the hip fracture service line. An internal data review of hip fracture cases before and after implementation of the pathway was undertaken to assess the impact of this model in terms of postoperative outcomes and resource utilization. The postimplementation group displayed more observant care while consuming fewer resources. Thus, the comanagement model described in this article serves as a powerful tool, allowing hospitals and physicians to improve the quality of care. This study provides recommendations based on our success in the hip fracture setting that may be extrapolated to improve service lines and healthcare efficiency nationally.
authors.affiliation: Gonzalo Barinaga, MD, Department of Surgery, Division of Orthopaedics and Sports Medicine, Southern Illinois University, Springfield; Zain Sayeed, MD, Department of Surgery, Chicago Medical School, North Chicago, Illinois; Afshin Anoushiravani, MD, NYU Langone Medical Center, Hospital for Joint Diseases, New York; Steven Scaife, Department of Surgery, Division of Orthopaedics and Sports Medicine, Southern Illinois University; and Mouhanad El-Othmani, MD, and Khaled Jamal Saleh, MD, FRCS, FACS, CPE, Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Michigan.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Barinaga
authors.forename: Zain
authors.initials: Z
authors.lastname: Sayeed
authors.forename: Afshin
authors.initials: A
authors.lastname: Anoushiravani
authors.forename: Steven
authors.initials: S
authors.lastname: Scaife
authors.forename: Mouhanad
authors.initials: M
authors.lastname: El-Othmani
authors.forename: Khaled Jamal
authors.initials: KJ
authors.lastname: Saleh
mesh_terms: D003695:Delivery of Health Care; D006620:Hip Fractures; D006801:Humans; D010348:Patient Care Team; D011788:Quality of Life