Effectiveness of a Multidisciplinary Approach to Geriatric Hip Fractures in Improving Clinical Outcomes and Cost of Care

Abstract

Background: Geriatric hip fracture is imposing a substantial burden on the healthcare system which requires intensive health service utilization during the first year of fracture. Multidisciplinary approach in form of clinical pathway has been reported to shorten hospital stay and improve clinical outcomes in the early 21st century. In 2007, a geriatric hip fracture clinical pathway (GHFCP) was developed to meet the local needs. The initial results were encouraging with shortened length of hospital stay. Method: Hip fracture data in 2006 were compared with those from 2008 to 2011 retrospectively. Efficiency of the programme was indicated by the preoperative length of stay and total length of stay in acute and convalescence hospitals. Clinical outcomes included short-term, long-term mortality rates; rate of complication; with cost of manpower being evaluated. Results: After implementation of the GHFCP, the preoperative length of stay shortened from 5.76 days to 1.32 days (p<0.001). The total length of stay in both acute and convalescence hospitals was also shortened by 6.05 and 14.24 days respectively. The rate of postoperative pneumonia decreased from 1.25% to 0.25%. Besides, the in-patient mortality, 30-day mortality, and 1-year mortality were dropped from 2.86%, 5.36% and 23.93% to 0.95%, 1.67% and 13.81% correspondingly. Furthermore, around 30% cut in average staff cost for each geriatric hip fracture patient (HK$23,907 to HK$16,598). The marked deduction in the manpower costs should be related to shortened length of stay despite extra workload generated from the GHFCP. Conclusion: Implementation of GHFCP resulted in shortened preoperative waiting time and length of hospitalization, decreased mortality and complication rates, reduced manpower cost and increased efficiency. Investment of manpower to manage the GHFCP is cost-effective. Yet, a larger-scale, prospective study is required to prove the efficacy of the multidisciplinary approach to geriatric hip fractures, and to identify factors that affect clinical outcomes.