Presented: American Geriatrics Society Annual Scientific Meeting, Presidential poster session, Las Vegas, NV, May 2004.
Effects of a Geriatrician-Led Hip Fracture Program: Improvements in Clinical and Economic Outcomes
Article first published online: 19 NOV 2008
© 2008, Copyright the Authors. Journal compilation © 2008, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 57, Issue 1, pages 159–167, January 2009
How to Cite
Miura, L. N., DiPiero, A. R. and Homer, L. D. (2009), Effects of a Geriatrician-Led Hip Fracture Program: Improvements in Clinical and Economic Outcomes. Journal of the American Geriatrics Society, 57: 159–167. doi: 10.1111/j.1532-5415.2008.02069.x
- Issue published online: 31 DEC 2008
- Article first published online: 19 NOV 2008
Vol. 57, Issue 6, 1134, Article first published online: 29 MAY 2009
- Hip Fracture Service;
- geriatrician hospitalist;
- cost effectiveness analysis;
The hip fracture service (HFS) is an interdisciplinary, geriatrician-led program instituted to improve the care of frail elderly people who present to the hospital with acute hip fracture. The HFS pilot project used existing hospital personnel and facilities and initiated new practices, including set protocols, preprinted orders, and standardized assessments, to achieve and evaluate patient triage and care and hospital cost savings. Outcome measures for 91 patients with acute hip fracture consecutively admitted to the HFS were compared with those of 72 historical controls managed under standard care in the prior year. Analysis demonstrated better outcomes in terms of length of stay (6.1±2.4 days for standard care, 4.6±1.1 days for the HFS; P<.001) and time to surgery (<24 hours after admission in 22.2% of standard care patients vs 50.5% of HFS patients; P<.001). Furthermore, the HFS model showed a reduction in total costs, resulting in a gain in net income, from a deficit of $908±4,977 (95% confidence interval (CI)=−$2,078–261) per patient in the standard group to a gain of $1,047±2,718 (95% CI=$481–1,613) per patient in the HFS group (P<.002). The findings suggest that care with set protocols overseen by a trained lead physician may improve the quality and cost effectiveness of managing elderly patients with hip fracture. Although the results must be interpreted with caution because of the pre-post design, this pilot study provides a model of care for further hypothesis generation and more rigorous testing into the quality and financial benefits of a geriatrics-led care process.