Measures of Clinical Outcome Before, During, and After Implementation of a Comprehensive Geriatric Hip Fracture Program

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.