PIT5 EXPERIENCE OF 2 INSTITUTIONS WITH THE GERIATRIC FRACTURE PROGRAM IN COLOMBIA: LENGTH OF STAY, MORTALITY AND ESTIMATION OF COSTS

Abstract Geriatric-orthopaedic co-management models have been demonstrated to improve patient outcomes, but are typically implemented in closed, non-pluralistic medial systems. The Cedars-Sinai Geriatric Fracture Program (GFP) was developed through collaboration amongst a multi-disciplinary group. Cedars-Sinai is an academic medical center with a pluralistic medical staff that includes faculty, several hospitalist groups, and private practitioners. The GFP was introduced in July 2018 as a quality improvement pilot to provide standardized treatment for geriatric fracture patients. We hypothesized GFP enrollment would reduce time to surgery (TTS) and length of stay (LOS). Geriatric fracture patients were prospectively enrolled from July -December 2018. The Wilcoxon Rank- Sum test was used to compare TTS and LOS between the two patient groups. A p < 0.05 was considered significant. 190 operative fractures in patients over 65 years-old were prospectively followed.56 (30%) were enrolled in the GFP, 54 (28%) were admitted to other hospitalist groups (OH), and 80 (42%) were managed by their primary care physician (PCP). There were no demographic differences between groups. Patients enrolled in the GFP had a significantly shorter LOS compared to the OH and PCP groups (4 days v 5 days v 5 days, p = 0.039) as well as a significantly shorter TTS (19.7hrs v 22.4 hrs vs 23.3 hrs, p = 0.037). Our data shows that a multi-disciplinary geriatric fracture program can be successfully implemented in a complex pluralistic environment resulting in improved patient metrics. Adherence to evidence-based protocols and close multidisciplinary teamwork are critical to program success.

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Implementing a Geriatric Fracture Program in a Mixed Practice Environment Reduces Total Cost and Length of Stay

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320987701 ◽

2021 ◽

Vol 12 ◽

pp. 215145932098770

Author(s):

Carol Lin ◽

Sonja Rosen ◽

Kathleen Breda ◽

Naomi Tashman ◽

Jeanne T. Black ◽

...

Keyword(s):

Length Of Stay ◽

Multidisciplinary Team ◽

Best Practice ◽

Hospital Costs ◽

Cost Savings ◽

Team Work ◽

Practice Environment ◽

Geriatric Fracture ◽

Geriatric Service ◽

Mixed Practice

Introduction: Geriatric-orthopaedic co-management models can improve patient outcomes. However, prior reports have been at large academic centers with “closed” systems and an inpatient geriatric service. Here we describe a Geriatric Fracture Program (GFP) in a mixed practice “pluralistic” environment that includes employed academic faculty, private practice physicians, and multiple private hospitalist groups. We hypothesized GFP enrollment would reduce length of stay (LOS), time to surgery (TTS), and total hospital costs compared to non-GFP patients. Materials and Methods: A multidisciplinary team was created around a geriatric Nurse Practitioner (NP) and consulting geriatrician. Standardized geriatric focused training programs and electronic tools were developed based on best practice guidelines. Fracture patients >65 years old were prospectively enrolled from July 2018 – June 2019. A trained biostatistician performed all statistical analyses. A p < 0.05 was considered significant. Results: 564 operative and nonoperative fractures in patients over 65 were prospectively followed with 153 (27%) enrolled in the GFP and 411 (73%) admitted to other hospitalists or their primary care provider (non-GFP). Patients enrolled in the GFP had a significantly shorter median LOS of 4 days, compared to 5 days in non-GFP patients (P < 0.001). There was a strong trend towards a shorter median TTS in the GFP group (21.5 hours v 25 hours, p = 0.066). Mean total costs were significantly lower in the GFP group ($25,323 v $29085, p = 0.022) Discussion: Our data shows that a geriatric-orthopaedic co-management model can be successfully implemented without an inpatient geriatric service, utilizing the pre-existing resources in a complex environment. The program can be expanded to include additional groups to improve care for entire geriatric fracture population with significant anticipated cost savings. Conclusions: With close multidisciplinary team work, a successful geriatric-orthopaedic comanagement model for geriatric fractures can be implemented in even a mixed practice environment without an inpatient geriatrics service.

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A Record-based Analysis of Profile, Pattern and Outcomes of Geriatric Fractures in a Tertiary CareHospital, Chandigarh

International Journal of Preventive Curative & Community Medicine ◽

10.24321/2454.325x.202112 ◽

2021 ◽

Vol 07 (03) ◽

pp. 12-16

Author(s):

Amarjeet Singh ◽

Keyword(s):

Length Of Stay ◽

Tertiary Care ◽

Lag Time ◽

Open Reduction Internal Fixation ◽

Geriatric Fracture ◽

Fracture Length ◽

Patient Arrival ◽

Tertiary Care Institution ◽

Spss Software ◽

Type Of Fracture

Introduction: Older people with diseased conditions are more prone to fracture irrespective of gender. Osteoporosis is the most common cause of elderly fractures. Objectives: 1) To ascertain the profile and pattern of geriatric fracture cases reporting a tertiary care institution, 2) To ascertain the extent of mortality and complications in geriatric fracture cases, and 3) To ascertain the functional outcomes of geriatric fracture cases discharged from the tertiary care institute. Methodology: A list of geriatric fracture inpatients of an institution was made for 2014 - 2018. The data on the profile of patients, type of fracture, treatment received, the lag time between the reporting and the surgery, comorbidities, past medical history, cause/ place of fracture, length of stay, and status at the time of the phone-based interview were analysed through SPSS software. Results: The highest range of the age for fracture occurrence was 60-70 years. Female patients were more than the male ones. Femur fracture was the most common. The most common direct cause of the fracture was fall (indoor). Open reduction, internal fixation and arthroplasty were the commonest treatment performed. The lag time between the patient arrival to the health care and surgery was 0-5 days. The highest length of stay by the patients in the hospital was 0-10 days. Conclusion: The possible direct causes of the fracture reported in the study were falls, roadside accidents, trauma etc.

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Analysis of the experience of the geriatric fracture program in two institutions in Colombia: a reproducible model?

Colombia Medica ◽

10.25100/cm.v52i3.4524 ◽

2021 ◽

Vol 52 (3) ◽

pp. e2034524

Author(s):

Carlos Mario Olarte ◽

Mauricio Zuluaga ◽

Adriana Guzman ◽

Julian Camacho ◽

Pieralessandro Lasalvia ◽

...

Keyword(s):

Length Of Stay ◽

Program Implementation ◽

Descriptive Study ◽

First Year ◽

Standard Methods ◽

Geriatric Fracture ◽

Number Of Patients ◽

Hospital Deaths ◽

Care Health

Background: hip fracture is the major cause of morbidity and mortality. Geriatric fracture programs promise to improve the quality of care, health outcomes and reduce costs. Objective: To describe the results related to the Geriatric fracture programs implementation in two Colombian institutions. These results could then be compared to other published experiences to assess reproducibility of the program. Methods: A retrospective descriptive study of the patients treated under the Geriatric fracture programs in two institutions in Colombia was carried out. The information of each institution was collected from the initial year of program implementation until 2018. Demographic characteristics, length of stay, hospitalization complications, readmissions and mortality were described. Consumption of healthcare resources was defined using base cases determined with local experts and costs were estimated using standard methods. Results: 475 patients were included in the Geriatric fracture programs in two institutions. We observed an increase in the number of patients during the Geriatric fracture programs. The length of stay decreased between 8.5% and 26.1% as did the proportion of total complications, with delirium having the greatest reduction. A similar situation was seen for first year mortality (from 10.9% to 4.7% in one institution and form 11.4% to 5.1% in the other), in-hospital deaths and readmissions. Estimates of costs of stay and complications showed reductions in all scenarios, varying between 22% and 68.3% depending on the sensitivity scenario. Conclusions: The present study presents the experience of two institutions that implemented the Geriatric fracture programs with increase in the number of patients treated and reductions in the time of hospital stay, the proportion of complications, readmissions, mortality, and estimated costs. These are similar between both institutions and with other published implementations. This could hint that geriatric fracture program may be implemented with reproducible results.

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