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Free Content Montefiore Comprehensive Model of Care for Elderly Patients with Hip Fractures

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Background: Hip fractures are highly prevalent in the geriatric population, accounting for significant morbidity, mortality, and health-care associated costs. Geriatrics hip fracture comanagement is a systems-based approach to optimize care of these patients, prevent further decompensation, and reduce costs associated with the inpatient stay and consequent sequelae. This study examines preliminary results after implementation of orthopaedic and geriatrics hip fracture comanagement at our large, urban, single center academic medical center.

Methods: This is a program evaluation comparing a novel multidisciplinary service with usual care in 120 consecutive, operatively managed hip fracture patients, aged 65 years or over, in 2011. Patients with pathologic fractures, multiple injury trauma, or requiring a monitored unit were excluded. Groups were compared for age, sex, revised cardiac risk index (RCRI), presence of delirium, and admission disposition. Outcome measures included time to surgery, perioperative complications, in-hospital mortality, length of stay (LOS), and 30 day readmission. Institutional Review Board approval was obtained prior to the implementation of this initiative.

Results: Mean age, sex, admission disposition, RCRI score, time to surgery, perioperative complications, in-hospital mortality, and 30 day readmission did not differ between the two groups. In the comanagement cohort, there was a significant increase of delirium diagnosis (3.8% versus 22%, p = 0.007) and a reduced length of stay (7.1 versus 4.9 days, p = 0.008).

Conclusions: The results from this preliminary programmatic implementation suggest that orthopaedic-geriatrics comanagement reduced LOS by 2 days. Complications, readmissions, and in-hospital deaths were similar. There were higher rates of delirium noted in the comanagement group, which we attribute to increased surveillance, detection, and documentation and similar to rates seen in comparable programs. Our investigation supports the experience in other centers in which a systems-based program with well-defined principles and protocols improves processes and outcomes for a common condition in a high-risk population.
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Document Type: Research Article

Affiliations: 1: Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York 2: Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York., Email: [email protected]

Publication date: March 1, 2016

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  • The Montefiore Journal of Musculoskeletal Medicine and Surgery is a peer-reviewed journal focused on publishing current clinical and basic science articles, as well as review articles and case reports that explore important topics in the diagnosis, treatment, and rehabilitation of musculoskeletal conditions. As the official publication of the Department of Orthopaedic Surgery, Montefiore Medical Center, and Albert Einstein College of Medicine, the journal is dedicated patient care and postgraduate medical education.
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