Related Experiment Video
Updated: Aug 30, 2025
Measuring Frailty in HIV-infected Individuals. Identification of Frail Patients is the First Step to Amelioration and Reversal of Frailty
Published on: July 24, 2013
Geriatric fracture program centering age-friendly care associated with lower length of stay and lower direct costs
Kathleen Breda1, Michelle S Keller2,3,4, Hiroshi Gotanda2,5,6
1Department of Orthopedics, Cedars-Sinai Medical Center, Beverly Hills, California, USA.
Objective:
To evaluate outcomes associated with an integrated inpatient and outpatient program aimed at optimizing the care of geriatric fracture patients in a mixed community and academic health system setting.
Data Sources And Study Setting:
This study took place at a tertiary-care, 886-bed hospital system. The Geriatric Fracture Program (GFP) was designed in 2018 using the 4Ms Framework (What Matters, Medication, Mentation, and Mobility). Patients ≥65 years old with non-spine fractures managed by orthopedic faculty surgeons and participating hospitalist groups were included. A fracture liaison team educated patients regarding bone health and ensured ambulatory geriatrics follow-up. Outpatient geriatric visits focused on mobility, fall risk, bone health imaging, and medications.
Study Design:
We compared GFP-enrolled patients (n = 746) to patients seen by non-GFP-participating physicians (n = 852) and used a generalized estimating equations approach and Poisson models to analyze associations between participation in the GFP program and four inpatient outcomes (time to surgery, length of stay, Vizient length of stay index, and total direct costs). We examined outcomes across all fractures and also stratified them by fracture type (hip vs. non-hip). We descriptively examined post-discharge care outcomes: fall, gait, and balance assessments; bone health imaging; and medications.
Data Collection/Extraction Methods:
We collected data through chart reviews/electronic health record extracts from July 2018 to June 2021.
Principal Findings:
GFP-enrolled patients with all fracture types had a significantly lower length of stay (marginal effect [ME]: -2.12, 95%CI: -2.61, -1.63), length of stay index (ME: -0.33, 95%CI: -0.42, -0.25), and total direct costs (ME: -$5316, 95%CI: -$6806, -$3826); the magnitude of the effects was greater for non-hip fractures. There was no significant difference in time to surgery. Of 746 GFP patients, 170 (23%) had a post-discharge visit with a participating geriatrician ≥6 months.
Conclusions:
A systematic approach to improving care for older adults with fractures improved length of stay and total direct costs.
Related Concept Videos
01:19Restorative Care
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:27Peripheral Artery Disease III: Interprofessional Care
01:29Bone Disorders
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...
01:29Documentation in Long-Term and Home Healthcare Setting
Long-Term Care Facilities
01:26Aging
Cellular Clock Theory
The cellular clock theory posits that the human lifespan is closely tied to the finite capacity of cells to divide, a phenomenon governed by telomeres, which are protective caps at the ends of...