Clinical and health-economic impact of orthogeriatric care models in Belgium: A population-based data registry study

doi:10.1007/s00198-025-07608-9

. 2025 Jul 14.

doi: 10.1007/s00198-025-07608-9. Online ahead of print.

Clinical and health-economic impact of orthogeriatric care models in Belgium: A population-based data registry study

Sigrid Janssens¹, Jeroen Luyten², Mieke Deschodt^{1

3}, An Sermon^{4

5}, Johan Flamaing^{1

6}, Marian Dejaeger^{7

8}

Affiliations

¹ Department of Public Health and Primary Care, Division of Gerontology and Geriatrics, KU Leuven, Herestraat 49, 3000, Louvain, Belgium.
² Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Louvain, Belgium.
³ Competence Centre of Nursing, University Hospital Leuven, Louvain, Belgium.
⁴ Department of Development and Regeneration, KU Leuven, Louvain, KU, Belgium.
⁵ Department of Traumatology, University Hospital Leuven, Louvain, Belgium.
⁶ Department of Geriatric Medicine, University Hospital Leuven, Louvain, Belgium.
⁷ Department of Public Health and Primary Care, Division of Gerontology and Geriatrics, KU Leuven, Herestraat 49, 3000, Louvain, Belgium. marian.dejaeger@uzleuven.be.
⁸ Department of Geriatric Medicine, University Hospital Leuven, Louvain, Belgium. marian.dejaeger@uzleuven.be.

PMID: 40658238
DOI: 10.1007/s00198-025-07608-9

Clinical and health-economic impact of orthogeriatric care models in Belgium: A population-based data registry study

Sigrid Janssens et al. Osteoporos Int. 2025.

. 2025 Jul 14.

doi: 10.1007/s00198-025-07608-9. Online ahead of print.

Authors

Sigrid Janssens¹, Jeroen Luyten², Mieke Deschodt^{1

3}, An Sermon^{4

5}, Johan Flamaing^{1

6}, Marian Dejaeger^{7

8}

Affiliations

¹ Department of Public Health and Primary Care, Division of Gerontology and Geriatrics, KU Leuven, Herestraat 49, 3000, Louvain, Belgium.
² Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Louvain, Belgium.
³ Competence Centre of Nursing, University Hospital Leuven, Louvain, Belgium.
⁴ Department of Development and Regeneration, KU Leuven, Louvain, KU, Belgium.
⁵ Department of Traumatology, University Hospital Leuven, Louvain, Belgium.
⁶ Department of Geriatric Medicine, University Hospital Leuven, Louvain, Belgium.
⁷ Department of Public Health and Primary Care, Division of Gerontology and Geriatrics, KU Leuven, Herestraat 49, 3000, Louvain, Belgium. marian.dejaeger@uzleuven.be.
⁸ Department of Geriatric Medicine, University Hospital Leuven, Louvain, Belgium. marian.dejaeger@uzleuven.be.

PMID: 40658238
DOI: 10.1007/s00198-025-07608-9

Abstract

This study evaluated six orthogeriatric care models for older fracture patients in Belgium. Integrated care on surgical wards reduced emergency department visits, while consultation on request on geriatric wards yielded the highest survival. All models had comparable costs except for integrated care on a geriatric ward, which was more expensive.

Purpose: This study assessed the (cost-)effectiveness of systematic collaboration (systematic consultation or integrated care) between surgical and geriatric teams compared to consultation on request in Belgium.

Methods: This registry-based study included patients aged ≥ 75 years admitted with hip, pelvis, wrist, shoulder, or vertebral fractures in 2019. We compared six care models: consultation on request, systematic consultation, or integrated care, on either surgical or geriatric wards. The primary outcome was 1-year mortality. Secondary outcomes included 30- and 90-day mortality, 1-year survival time, length of stay (LOS), 30- and 90-day emergency department (ED) visits and unplanned readmissions, and 1-year institutionalization. Cost-effectiveness was assessed using survival time and total direct costs within one year.

Results: We analyzed 8,302 patients across 60 hospitals. LOS was shortest for consultation on request on surgical (10 days) and geriatric wards (12 days), and for integrated care on a surgical ward (11 days). ED visits at 30 (5.9%) and 90 days (11.0%) were lowest for integrated care on a surgical ward. Survival time was highest for consultation on request on a geriatric ward. Mortality, institutionalization, and unplanned readmissions were similar across models. Costs were mostly comparable (€16,445-€17,829) except for integrated care on a geriatric ward, which was more expensive (€18,726).

Conclusion: Integrated care on a surgical ward reduced ED visits without compromising outcomes. While consultation on request on a geriatric ward showed the highest survival time at similar cost, absolute differences were minimal, thereby emphasizing the overall health-economic comparability across models.

Keywords: Belgium; Cost-effectiveness analysis; Orthogeriatric co-management; Osteoporotic fractures.

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Conflict of interest statement

Declarations. Ethical approval: The study was consistent with the Helsinki Declaration’s ethical standards. This study met the requirements of the General Data Protection Regulation, as confirmed by the Privacy and Ethics Committee of KU Leuven (G-2022–6131), and was ethically approved by the Belgian Information Safety Committee (IVC/KSZG/23/230). Informed consent: Informed consent was waived because of the retrospective nature of the study. Conflict of interest: Sigrid Janssens, Jeroen Luyten, Mieke Deschodt, An Sermon, Johan Flamaing, and Marian Dejaeger declare that they have no conflict of interest.

References

1. Janssens S, Gielen E, Laurent MR et al (2024) Hospitalizations for hip and non-hip osteoporotic fractures in Belgium: nationwide trends between 2010 and 2021. Arch Osteoporos 19:62. https://doi.org/10.1007/S11657-024-01423-1 - DOI - PubMed
1. Ong T, Sahota O, Gladman JRF (2020) The Nottingham Spinal Health (NoSH) Study: a cohort study of patients hospitalised with vertebral fragility fractures. Osteoporos Int 31:363–370. https://doi.org/10.1007/s00198-019-05198-x - DOI - PubMed
1. Banierink H, ten Duis K, Prijs J et al (2021) What is the long-term clinical outcome after fragility fractures of the pelvis? - A CT-based cross-sectional study. Injury Published Online First. https://doi.org/10.1016/j.injury.2021.09.056 - DOI
1. Tran T, Bliuc D, Hansen L et al (2018) Persistence of excess mortality following individual nonhip fractures: a relative survival analysis. J Clin Endocrinol Metab 103:3205–3214. https://doi.org/10.1210/jc.2017-02656 - DOI - PubMed
1. Cooper C, Cummings S, Lyons A et al (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:S12. https://doi.org/10.1016/s0002-9343(97)90022-x - DOI

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[1] Janssens S, Gielen E, Laurent MR et al (2024) Hospitalizations for hip and non-hip osteoporotic fractures in Belgium: nationwide trends between 2010 and 2021. Arch Osteoporos 19:62. https://doi.org/10.1007/S11657-024-01423-1 - DOI - PubMed

[2] Janssens S, Gielen E, Laurent MR et al (2024) Hospitalizations for hip and non-hip osteoporotic fractures in Belgium: nationwide trends between 2010 and 2021. Arch Osteoporos 19:62. https://doi.org/10.1007/S11657-024-01423-1 - DOI - PubMed

[3] Ong T, Sahota O, Gladman JRF (2020) The Nottingham Spinal Health (NoSH) Study: a cohort study of patients hospitalised with vertebral fragility fractures. Osteoporos Int 31:363–370. https://doi.org/10.1007/s00198-019-05198-x - DOI - PubMed

[4] Ong T, Sahota O, Gladman JRF (2020) The Nottingham Spinal Health (NoSH) Study: a cohort study of patients hospitalised with vertebral fragility fractures. Osteoporos Int 31:363–370. https://doi.org/10.1007/s00198-019-05198-x - DOI - PubMed

[5] Banierink H, ten Duis K, Prijs J et al (2021) What is the long-term clinical outcome after fragility fractures of the pelvis? - A CT-based cross-sectional study. Injury Published Online First. https://doi.org/10.1016/j.injury.2021.09.056 - DOI

[6] Banierink H, ten Duis K, Prijs J et al (2021) What is the long-term clinical outcome after fragility fractures of the pelvis? - A CT-based cross-sectional study. Injury Published Online First. https://doi.org/10.1016/j.injury.2021.09.056 - DOI

[7] Tran T, Bliuc D, Hansen L et al (2018) Persistence of excess mortality following individual nonhip fractures: a relative survival analysis. J Clin Endocrinol Metab 103:3205–3214. https://doi.org/10.1210/jc.2017-02656 - DOI - PubMed

[8] Tran T, Bliuc D, Hansen L et al (2018) Persistence of excess mortality following individual nonhip fractures: a relative survival analysis. J Clin Endocrinol Metab 103:3205–3214. https://doi.org/10.1210/jc.2017-02656 - DOI - PubMed

[9] Cooper C, Cummings S, Lyons A et al (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:S12. https://doi.org/10.1016/s0002-9343(97)90022-x - DOI

[10] Cooper C, Cummings S, Lyons A et al (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:S12. https://doi.org/10.1016/s0002-9343(97)90022-x - DOI

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Clinical and health-economic impact of orthogeriatric care models in Belgium: A population-based data registry study

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Clinical and health-economic impact of orthogeriatric care models in Belgium: A population-based data registry study

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