The effectiveness of a multidisciplinary hip fracture care model in improving the clinical outcome and the average cost of manpower

被引:25
作者
Lau, T. W. [1 ]
Fang, C. [1 ]
Leung, F. [1 ]
机构
[1] Univ Hong Kong, Queen Mary Hosp, Dept Orthopaed & Traumatol, 102 Pokfulam Rd, Pok Fu Lam, Hong Kong, Peoples R China
关键词
Cost of care; Geriatric hip fracture; Mortality rates; Multidisciplinary; QUALITY-OF-CARE; ELDERLY-PATIENTS; MORTALITY; PATHWAY; SURGERY; COHORT; FEMUR; NECK; OSTEOPOROSIS; POPULATION;
D O I
10.1007/s00198-016-3845-7
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
After the implementation of the multidisciplinary geriatric hip fracture clinical pathway in 2007, the hospital length of stay and the clinical outcomes improves. Moreover, the cost of manpower for each hip fracture decreases. It proves that this care model is cost-effective. The objective of this study is to compare the clinical outcomes and the cost of manpower before and after the implementation of the multidisciplinary geriatric hip fracture clinical pathway (GHFCP). The hip fracture data from 2006 was compared with the data of four consecutive years since 2008. The efficiency of the program is assessed using the hospital length of stay. The clinical outcomes include mortality rates and complication rates are compared. Cost of manpower was also analysed. After the implementation of the GHFCP, the preoperative length of stay shortened significantly from 5.8 days in 2006 to 1.3 days in 2011. The total length of stay in both acute and rehabilitation hospitals were also shortened by 6.1 days and 14.2 days, respectively. The postoperative pneumonia rate also decreased from 1.25 to 0.25%. The short- and long-term mortalities also showed a general improvement. Despite allied health manpower was increased to meet the increased workload, the shortened length of stay accounted for a mark decrease in cost of manpower per hip fracture case. This study proves that the GHFCP shortened the geriatric hip fracture patients' length of stay and improves the clinical outcomes. It is also cost-effective which proves better care is less costly.
引用
收藏
页码:791 / 798
页数:8
相关论文
共 29 条
[1]   Reduced morbidity for elderly patients with a hip fracture after implementation of a perioperative evidence-based clinical pathway [J].
Beaupre, L. A. ;
Cinats, J. G. ;
Senthilselvan, A. ;
Lier, D. ;
Jones, C. A. ;
Scharfenberger, A. ;
Johnston, D. W. C. ;
Saunders, L. D. .
QUALITY & SAFETY IN HEALTH CARE, 2006, 15 (05) :375-379
[2]   Mortality associated with delay in operation after hip fracture: observational study [J].
Bottle, A ;
Aylin, P .
BMJ-BRITISH MEDICAL JOURNAL, 2006, 332 (7547) :947-950
[3]   The economic cost of hip fractures in community-dwelling older adults: A prospective study [J].
Brainsky, A ;
Glick, H ;
Lydick, E ;
Epstein, R ;
Fox, KM ;
Hawkes, W ;
Kashner, TM ;
Zimmerman, SI ;
Magaziner, J .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 1997, 45 (03) :281-287
[4]  
British Orthopaedic Association, 2007, CAR FRAG FRACT PAT
[5]   Analysis of Past Secular Trends of Hip Fractures and Predicted Number in the Future 2010-2050 [J].
Brown, Christopher A. ;
Starr, Aijing Z. ;
Nunley, James A. .
JOURNAL OF ORTHOPAEDIC TRAUMA, 2012, 26 (02) :117-122
[6]   Clinical pathway for fractured neck of femur: a prospective, controlled study [J].
Choong, PFM ;
Langford, AK ;
Dowsey, MM ;
Santamaria, NM .
MEDICAL JOURNAL OF AUSTRALIA, 2000, 172 (09) :423-426
[7]   Predictors of outcome following hip fracture. Admission time predicts length of stay and in-hospital mortality [J].
Clague, JE ;
Craddock, E ;
Andrew, G ;
Horan, MA ;
Pendleton, N .
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, 2002, 33 (01) :1-6
[8]   Secular trends in the incidence of hip and other osteoporotic fractures [J].
Cooper, C. ;
Cole, Z. A. ;
Holroyd, C. R. ;
Earl, S. C. ;
Harvey, N. C. ;
Dennison, E. M. ;
Melton, L. J. ;
Cummings, S. R. ;
Kanis, J. A. .
OSTEOPOROSIS INTERNATIONAL, 2011, 22 (05) :1277-1288
[9]  
Fergus L, 2011, NEW ZEAL MED J, V124, P40
[10]   Mortality after hip fracture in the elderly: The role of a multidisciplinary approach and time to surgery in a retrospective observational study on 23,973 patients [J].
Forni, Silvia ;
Pieralli, Francesca ;
Sergi, Alessandro ;
Lorini, Chiara ;
Bonaccorsi, Guglielmo ;
Vannucci, Andrea .
ARCHIVES OF GERONTOLOGY AND GERIATRICS, 2016, 66 :13-17