Effects of a geriatrician-led hip fracture program: Improvements in clinical and economic outcomes

Lisa N. Miura, Albert R. Dipiero, Louis D. Homer

Research output: Contribution to journalArticle

51 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)159-167
Number of pages9
JournalJournal of the American Geriatrics Society
Volume57
Issue number1
DOIs
StatePublished - Jan 2009

Keywords

  • Cost effectiveness analysis
  • Geriatrician hospitalist
  • Hip Fracture Service
  • Inpatient

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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