Original Research

Effects of a hospitalist care model on mortality of elderly patients with hip fractures†‡

  1. John A. Batsis MD1,2,
  2. Michael P. Phy DO3,
  3. L. Joseph Melton III MD4,
  4. Cathy D. Schleck BS5,
  5. Dirk R. Larson MS5,
  6. Paul M. Huddleston MD6,
  7. Jeanne M. Huddleston MD7,8,*

Article first published online: 7 AUG 2007

DOI: 10.1002/jhm.207

Issue

Journal of Hospital Medicine

Journal of Hospital Medicine

Volume 2, Issue 4, pages 219–225, July/August 2007

Additional Information

How to Cite

Batsis, J. A., Phy, M. P., Joseph Melton, L., Schleck, C. D., Larson, D. R., Huddleston, P. M. and Huddleston, J. M. (2007), Effects of a hospitalist care model on mortality of elderly patients with hip fractures. J. Hosp. Med., 2: 219–225. doi: 10.1002/jhm.207

Author Information

  1. 1

    Division of Primary Care Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota

  2. 2

    Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, Rochester, Minnesota

  3. 3

    Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas

  4. 4

    Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, Minnesota

  5. 5

    Division of Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota

  6. 6

    Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota

  7. 7

    Hospital Internal Medicine, Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota

  8. 8

    Division of Health Care Policy and Research, Mayo Clinic College of Medicine, Rochester, Minnesota

*Mayo Clinic College of Medicine, Hospital Internal Medicine, Department of Medicine, Rochester, MN 55905; Fax: (507) 255-1027

  1. †

    Presented in part at the American Association of Orthopedic Surgeons Annual Conference, Chicago, Illinois, March 22–26, 2006 and the American Geriatrics Society 2007 Annual Scientific Meeting, Seattle, Washington, May 2–6, 2007.

  2. ‡

    Accepted for presentation to the American Geriatrics Society 2007 Annual Scientific Meeting, Seattle, Washington, May 2-6, 2007.

Publication History

  1. Issue published online: 7 AUG 2007
  2. Article first published online: 7 AUG 2007
  3. Manuscript Accepted: 28 FEB 2007
  4. Manuscript Revised: 2 FEB 2007
  5. Manuscript Received: 24 NOV 2006

Funded by

  • Hospital Medicine Fellowship Program, Mayo Clinic, Rochester, MN

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Keywords:

  • hospitalist as consultant;
  • geriatric patient;
  • osteoporosis;
  • post-operative evaluation

Abstract

BACKGROUND

We previously demonstrated that a hospitalist service created to medically manage patients with hip fracture reduced time to surgery and length of hospital stay, with no difference in inpatient mortality, compared with patients who received standard care. Whether this improved efficiency affects long-term mortality is unknown.

OBJECTIVE

This study examined the effects of this hospitalist service versus standard care on mortality up to 1 year and identified predictors of mortality in patients with hip fracture.

DESIGN

Retrospective cohort study.

SETTING

Tertiary care center.

PATIENTS

Four hundred and sixty-six consecutive patients admitted for surgical repair of a hip fracture in 2000–2002 with 93% 1-year follow-up.

RESULTS

There was no significant difference in survival of the patients between those on the hospitalist care service and those on the standard care service (70.5% [CI: 64.8%, 76.7%] vs. 70.6% [CI: 64.9%, 76.8%]; P = .36), despite the shortened time to surgery and decreased length of stay in the hospitalist group. Predictors of mortality included: admission from a nursing home (hazard ratio [HR] 2.24, [CI: 1.73, 2.90]); age at admission (HR 1.17 [CI: 0.99, 1.38]); inpatient complications, including ICU admission, myocardial infarction, or acute renal failure (HR 1.85 [CI: 1.45, 2.35]); and ASA class III or IV compared with ASA class II (HR 4.20 [CI: 2.21, 7.99]).

CONCLUSIONS

The improved efficiency in reducing length of stay and time to surgery in the hospitalist group did not adversely affect long-term mortality of this patient population. Journal of Hospital Medicine 2007;2:219–225. © 2007 Society of Hospital Medicine.

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