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J Orthop Trauma. 2013 Dec;27(12):672-6. doi: 10.1097/BOT.0b013e318291f0e5.

Measures of clinical outcome before, during, and after implementation of a comprehensive geriatric hip fracture program: is there a learning curve?

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  • 1*Texas Health Harris Methodist Hospital Fort Worth; Fort Worth, TX; †Orthopaedic Surgery Residency Program, John Peter Smith Hospital, Fort Worth, TX; ‡San Antonio Military Medical Center, San Antonio, TX; and §Orthopedic Specialty Associates, Fort Worth, TX.

Abstract

OBJECTIVES:

To evaluate the effects of implementing a multidisciplinary geriatric hip fracture program on clinical outcome measures at our institution.

DESIGN:

Retrospective comparative cohort study of consecutive patients treated before, during, and after implementation of this program, including patient data from electronic medical records and state death records.

SETTING:

Single metropolitan level 2 regional trauma center and community hospital.

PATIENTS/PARTICIPANTS:

Patients aged 60 years and older with operatively treated low-energy hip fractures were included. Patients with active cancer or a high-energy mechanism (motor vehicle crash or fall >3 ft) were excluded.

INTERVENTION:

Patients were divided into 1 of 3 groups: (1) those treated before our hip fracture program (July 2008-April 2009), (2) during implementation of the hip fracture program (May 2009-Feb 2010), and (3) after the hip fracture program was instituted and participation was well established (March 2010-Dec 2010).

MAIN OUTCOME MEASURES:

Patient demographics, injury factors, and clinical outcomes, including performance measures (eg, time to medical clearance and surgery and length of stay) and patient deaths (in-hospital, 30 days, and 1 year), were compared.

RESULTS:

There was significant improvement in clinical performance measures, including time to surgery and length of stay during and after implementation of our geriatric hip fracture program. The in-hospital mortality rate increased during the implementation phase of this program (P = 0.04). Once established, however, the in-hospital mortality decreased to a more typical level. Thirty-day and 1-year mortality rates were not significantly different among the 3 groups.

CONCLUSIONS:

Most clinical outcome measures improved significantly with implementation of our geriatric hip fracture program. Increased in-hospital mortality, however, was an unintended consequence seen while establishing this program and may represent a learning curve by health care providers. Patient demise in the longer term seemed to be unaffected by implementation of the program.

LEVEL OF EVIDENCE:

Therapeutic level III.

PMID:
23515124
[PubMed - indexed for MEDLINE]
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