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Orthogeriatric care pathway: a prospective survey of impact on length of stay, mortality and institutionalisation

Suhm, N. ; Kaelin, R. ; Studer, P. ; Wang, Q. ; Kressig, R. ; Rikli, D. ; Jakob, M. ; Pretto, M.

In: Archives of Orthopaedic and Trauma Surgery, 2014, vol. 134, no. 9, p. 1261-1269

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    Titre
    • Orthogeriatric care pathway: a prospective survey of impact on length of stay, mortality and institutionalisation
    Auteur
    • Suhm, N.. Traumatology, Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Kaelin, R.. Traumatology, Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Studer, P.. Traumatology, Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Wang, Q.. Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
    • Kressig, R.. Felix Platter Hospital, University Center for Medicine of Aging Basel, Basel, Switzerland
    • Rikli, D.. Traumatology, Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Jakob, M.. Traumatology, Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Pretto, M.. Nursing Department, University Hospital Basel, Basel, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Archives of Orthopaedic and Trauma Surgery, 2014, vol. 134, no. 9, p. 1261-1269. Springer Berlin Heidelberg
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:326097
    Summary
    Introduction: Care pathways for elderly hip fracture patients are increasingly implemented but there has been only limited evaluation of their use. Our objective was to investigate the impact of such a care pathway on the use of healthcare resources and on patients' outcomes. Materials and methods: The prospective survey covered 493 hip fracture patients 65years of age or older that were treated either before "Usual Care=(UC)” or after "Co-Managed-Care=(CMC)” implementation of the care pathway. Primary outcome was length of stay (LoS). Secondary outcomes were 1-year mortality and change in residential status from prefracture baseline to 1-year after surgery. Data were analysed by descriptive and interferential statistics and adjustment for baseline differences amongst the two patient groups was done. Results: Patients in the CMC sample had more preexisting comorbidities (CCI 2.5 versus 2.1). Prior to the fracture, a larger proportion amongst them needed help in ADL (49 versus 26%), and they were more likely to reside in a nursing home (36 versus 29%). Prefracture mobility status was equal in both samples. In the CMC sample LoS was significantly shorter (LoS 8.6 versus 11.3days, p<0.01) and patients were less likely to experience a complication (59 vs 73%, p<0.01) while being in the hospital. There was no significant difference in 1-year mortality or in change of residential status. Conclusions: A care pathway for elderly hip fracture patients allowed decreased LoS without affecting mortality or change of residential status 1year after fracture compared to prefracture baseline.