[Multidisciplinary integrated care pathway for elderly patients with hip fractures: implementation results from Centre for Geriatric Traumatology, Almelo, The Netherlands]

Abstract

Objective: To evaluate the effects of the implementation of a multidisciplinary treatment approach at Hospital Group Twente in Almelo, Netherlands, of hip fracture patients aged 65 years and older.

Design: Historical comparative cohort study.

Method: Two groups of patients with hip fractures were retrospectively compared. One of these groups had been treated in 2009 according to the new, multidisciplinary treatment approach; the other in 2007 by usual means. Observations included the duration of hospital stay, as well as the numbers of complications, readmissions and consultations by other specialities.

Results: Included were 101 patients from 2009 and 69 from 2007. In 2009, the mean duration of hospital stay was 1 day longer than in 2007. Patients admitted to a nursing home for rehabilitation increased by 16 percentage points. The incidence of minor complications decreased by 7 percentage points; that of severe complications, 5 percentage points. The diagnosis of delirium was made significantly more often (15 percentage points more; p-value: 0.051). The rate of death decreased by 5 percentage points. The number of readmissions within 30 days declined by 14 percentage points (p-value: 0.001). Due to geriatric co-treatment (co-managed care), consultations by various specialities were fewer per patient.

Conclusion: No reduction in the duration of hospital stay was achieved by implementation of the multidisciplinary treatment approach. It did appear that a relationship with better short-term treatment outcomes for the elderly with hip fractures existed.