OTA 2012 Posters

Scientific Poster #21 Hip/Femur OTA-2012

Δ Management of Hip Fracture Patients Using a Standardized Perioperative Approach Combined With a Medical Home (MH) Primary Care Model: A New Standard for Better Outcomes?

Jove H. Graham, PhD; Thomas R. Bowen, MD; Kent A. Strohecker, MS;
Kaan S. Irgit, MD; Wade R. Smith, MD;
Geisinger Health System, Danville, Pennsylvania, USA

Background/Purpose: Hip fracture patients continue to experience high morbidity and mortality rates in the first postoperative year, and significant complications occur most often after discharge. Postdischarge care management using a Medical Home (MH) model attempts to reduce such complications, particularly in patients with medical comorbidities, by using nurse case managers to coordinate the transition from hospital to home and subsequent care. Case managers use early telephone outreach, medication reconciliation, social support assistance, and ensure timely follow-up with primary care physicians in the months immediately following surgery. We compared rates of mortality, hospitalizations, emergency department (ED) visits, and prescription orders between two prospective cohorts of hip fracture patients, both managed with identical perioperative protocols and one group subsequently managed via MH. We hypothesized that the best outcomes would occur in patients managed initially with a standardized approach, early surgery, and subsequent MH management.

Methods: We analyzed 6- and 12-month outcomes from a prospective cohort of 194 patients who were surgically treated for hip fracture from 2010 to 2011 at two hospitals, half of whom received MH care. Mean age was 82 years (range, 62-100), and 28% of patients were male. MH patients were matched to patients who received identical in-hospital protocols but did not receive MH, on the basis of surgery date (±90 days), sex, age, and major comorbidities using a 1:1 ratio and propensity scoring methods. Mortality rates, hospitalizations, ED visits, and prescriptions per patient were compared between the two cohorts using log-rank survival analysis and Poisson regression (expressed as odds ratios [OR]) with P <0.05 considered significant.

Results: At 6 months postoperatively, MH patients had a significantly lower mortality rate than patients receiving standard care (11 vs 26%, respectively; P <0.01). At 12 months, a difference persisted (23 vs 30%, P = 0.12), although it was no longer statistically significant. Differences in all-cause hospitalizations, ED visits, and prescription orders per patient were similar at 12 months (OR 0.9, 1.3, and 1.4; P = 0.83, 0.42, and 0.16, respectively).

Conclusion: Patients receiving aggressive postdischarge care from a Medical Home program showed significant benefits in terms of reduced mortality and trends toward reduced hospitalizations in the time period following hip fracture. Postsurgical care of elderly, multicomorbid patients is complex, but these results suggest that ongoing MH management can benefit patients and may reduce costs.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.