Effects of a Hospitalist Care Model on Mortality of Elderly Patients with Hip Fractures

Citation

Batsis, John A.; Phy, Michael P.; Melton, L. Joseph, 3rd; Schleck, Cathy D.; Larson, Dirk R.; Huddleston, Paul M.; & Huddleston, Jeanne M. (2007). Effects of a Hospitalist Care Model on Mortality of Elderly Patients with Hip Fractures. Journal of Hospital Medicine, 2(4), 219-225.

Abstract

BACKGROUND: We previously demonstrated that a hospitalist service created to medically manage patients with hip fracture reduced time to surgery and length of hospital stay, with no difference in inpatient mortality, compared with patients who received standard care. Whether this improved efficiency affects long-term mortality is unknown. OBJECTIVE: This study examined the effects of this hospitalist service versus standard care on mortality up to 1 year and identified predictors of mortality in patients with hip fracture.
DESIGN: Retrospective cohort study.
SETTING: Tertiary care center.
PATIENTS: Four hundred and sixty-six consecutive patients admitted for surgical repair of a hip fracture in 2000-2002 with 93% 1-year follow-up.
RESULTS: There was no significant difference in survival of the patients between those on the hospitalist care service and those on the standard care service (70.5% [CI: 64.8%, 76.7%] vs. 70.6% [CI: 64.9%, 76.8%]; P = .36), despite the shortened time to surgery and decreased length of stay in the hospitalist group. Predictors of mortality included: admission from a nursing home (hazard ratio [HR] 2.24, [CI: 1.73, 2.90]); age at admission (HR 1.17 [CI: 0.99, 1.38]); inpatient complications, including ICU admission, myocardial infarction, or acute renal failure (HR 1.85 [CI: 1.45, 2.35]); and ASA class III or IV compared with ASA class II (HR 4.20 [CI: 2.21, 7.99]).
CONCLUSIONS: The improved efficiency in reducing length of stay and time to surgery in the hospitalist group did not adversely affect long-term mortality of this patient population.

URL

http://dx.doi.org/10.1002/jhm.207

Reference Type

Journal Article

Year Published

2007

Journal Title

Journal of Hospital Medicine

Author(s)

Batsis, John A.
Phy, Michael P.
Melton, L. Joseph, 3rd
Schleck, Cathy D.
Larson, Dirk R.
Huddleston, Paul M.
Huddleston, Jeanne M.

ORCiD

Batsis - 0000-0002-0845-4416