ArticleThe Permanente journal2017
Geriatric Hip Fracture Care: Fixing a Fragmented System.
Article in The Permanente journal, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 5 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
14 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Do we understand each other when we develop and implement hip fracture models of care? A systematic review with narrative synthesis.BMJ open quality · 2023Pooled it
- The integrated structure of care: evidence for the efficacy of models of clinical governance in the prevention of fragility fractures after recent sentinel fracture after the age of 50 years.Archives of osteoporosis · 2023Pooled it
- Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021.Frontiers in endocrinology · 2023Pooled it
- Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures: A Systematic Review.JAMA network open · 2022Pooled it
- Systems approach to health service design, delivery and improvement: a systematic review and meta-analysis.BMJ open · 2021Pooled it
- Trends, disease burden, and cause patterns of hip fracture among older adults from 1990 to 2023 in mainland China.Archives of osteoporosis · 2026Article
- New horizons in systems engineering and thinking to improve health and social care for older people.Age and ageing · 2024Article
- Implementation of a geriatric care bundle for older adults with acute burns.Burns : journal of the International Society for Burn Injuries · 2024Article
- Contextual Determinants of Time to Surgery for Patients With Hip Fracture.JAMA network open · 2023Article
- Merits of Surgical Comanagement of Patients With Hip Fracture by Dedicated Orthopaedic Hospitalists.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2021Article
- Postacute Management of Older Adults Suffering an Osteoporotic Hip Fracture: A Consensus Statement From the International Geriatric Fracture Society.Geriatric orthopaedic surgery & rehabilitation · 2020Review
- Quality Measures and Quality Improvement Initiatives in Osteoporosis-an Update.Current osteoporosis reports · 2019Review
- Fixing a Fragmented System: Impact of a Comprehensive Geriatric Hip Fracture Program on Long-Term Mortality.The Permanente journal · 2019Article
- Orthogeriatrics and Hip Fracture Care in the UK: Factors Driving Change to More Integrated Models of Care.Geriatrics (Basel, Switzerland) · 2018Review
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
contextFragmentation in geriatric hip fracture care is a growing concern because of the aging population. Patients with hip fractures at our institution historically were admitted to multiple different services and units, leading to unnecessary variation in inpatient care. Such inconsistency contributed to delays in surgery, discharge, and functional recovery; hospital-acquired complications; failure to adhere to best practices in osteoporosis management; and poor coordination with outpatient practitioners.
objectiveTo describe a stepwise approach to systems redesign for this patient population.
designWe designed and implemented a comprehensive geriatric hip fracture program for patients aged 65 years and older at our academic Medical Center in October 2014. Key interventions included admission of all ward-status patients to the Orthopedics Service with hospitalist comanagement; geographic placement on the Orthopedics Unit; and standardized, evidence-based electronic order sets bundling geriatric best practices and a streamlined workflow for discharge planning.
main outcome measuresHospital length of stay.
resultsWe identified 271 admissions among 267 patients between January 1, 2012, and March 31, 2016; of those, 154 were before and 117 were after program implementation. Mean hospital length of stay significantly improved from 6.4 to 5.5 days (p = 0.004). The 30-day all-cause readmission rate and discharge disposition remained stable. The percentage of patients receiving osteoporosis evaluation and treatment increased significantly. The rate of completed 30-day outpatient follow-up also improved.
conclusionOur comprehensive geriatric hip fracture program achieved and sustained gains in the quality and efficiency of care by improving fragmentation in the health care system.
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