Get access

Effects of a Geriatrician-Led Hip Fracture Program: Improvements in Clinical and Economic Outcomes

Authors

  • Lisa N. Miura MD,

    1. From the *Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, Oregon; and Department of Medicine, Legacy Health System, Portland, Oregon.
    Search for more papers by this author
  • Albert R. DiPiero MD, MPH,

    1. From the *Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, Oregon; and Department of Medicine, Legacy Health System, Portland, Oregon.
    Search for more papers by this author
  • Louis D. Homer MD, PhD

    1. From the *Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, Oregon; and Department of Medicine, Legacy Health System, Portland, Oregon.
    Search for more papers by this author

Errata

This article is corrected by:

  1. Errata: ERRATUM Volume 57, Issue 6, 1134, Article first published online: 29 May 2009

  • Presented: American Geriatrics Society Annual Scientific Meeting, Presidential poster session, Las Vegas, NV, May 2004.

Address correspondence to Lisa N. Miura, 2800 N. Vancouver, Suite #230, Portland, OR 97227. E-mail: lmiura@lhs.org

Abstract

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.

Ancillary