Implementation of a Comprehensive Hip Fracture Care Program in a Community Hospital Setting

Abstract

Introduction: Hip fractures are common and costly in the elderly population, often contributing to loss of function and independence. Prompt surgical care may improve clinical and economic outcomes. Materials and Methods: We implemented a protocol-driven care program focused on minimizing time spent immobilized awaiting surgery and streamlining the care pathway for hip fracture. The Hip Fracture Care Program (HFCP) was implemented in a single facility in the Willis Knighton Health System. Time to surgery, length of stay, and cost of length of stay were compared before and after the intervention, utilizing an interrupted time series analysis to account for background trends. Results: One-hundred and sixty patients received HFCP care for acute femur fracture requiring surgical fixation. Compared to 379 patients serving as the pre-implementation comparison group, patients receiving the HFCP intervention were more likely to have minor disease severity and mortality risk. Bivariate analysis demonstrated HFCP was associated with a reduced mean length of stay (from 5.99 to 5.33, p=0.016). Interrupted time series analysis adjusting for disease severity showed no statistically significant difference in length of stay or time to surgery after implementation of the intervention. Mean overall cost based on length of stay was reduced in the post-intervention period, but results were not statistically significant. Discussion: Early cost savings are promising, and program refinement may translate to additional utilization improvements and implications for value-based health care delivery. Conclusions: A standardized care program can be successfully implemented in a community hospital. The program led to nonsignificant reductions in overall LOS and estimated cost savings attributable to LOS reductions. Further efforts to evaluate the effect on complications and other patient-centered outcomes are needed.