Orthogeriatric care pathway: a prospective survey of impact on length of stay, mortality and institutionalisation

Care pathways for elderly hip fracture patients are increasingly implemented but there has been only limited evaluation of their use. Our objective was to investigate the impact of such a care pathway on the use of healthcare resources and on patients' outcomes. The prospective survey covered 493 hip fracture patients 65 years of age or older that were treated either before Usual Care = (UC) or after Co-Managed-Care = (CMC) implementation of the care pathway. Primary outcome was length of stay (LoS). Secondary outcomes were 1-year mortality and change in residential status from prefracture baseline to 1-year after surgery. Data were analysed by descriptive and interferential statistics and adjustment for baseline differences amongst the two patient groups was done. Patients in the CMC sample had more preexisting comorbidities (CCI 2.5 versus 2.1). Prior to the fracture, a larger proportion amongst them needed help in ADL (49 versus 26 %), and they were more likely to reside in a nursing home (36 versus 29 %). Prefracture mobility status was equal in both samples. In the CMC sample LoS was significantly shorter (LoS 8.6 versus 11.3 days, p < 0.01) and patients were less likely to experience a complication (59 vs 73 %, p < 0.01) while being in the hospital. There was no significant difference in 1-year mortality or in change of residential status. A care pathway for elderly hip fracture patients allowed decreased LoS without affecting mortality or change of residential status 1 year after fracture compared to prefracture baseline.