Comparison of an Organized Geriatric Fracture Program to United States Government Data

摘要

Objective: This study describes the financial impact of an organized hip fracture program for elderly patients age 65 years and older. Methods: This is a retrospective study of 797 fractures in 776 consecutive patients over a 50-month period (May 2005 to July 2009) treated in an organized hip fracture program for the elderly identified from a quality management database. Financial, demographic, and quality-of-care data were collected. The length of hospital stay, in-hospital complications, and Charlson comorbidity scores were collected from patient records, and all data were evaluated using standard statistical methods. Setting: 261-bed community-based, university-affiliated teaching hospital in an urban setting with a catchment area of approximately 1 million persons. This is a level 3 trauma center. Results: The average total net revenue per hip fracture was $12?159, with an average total cost to hospital of $8264. Physicians' fees consisted of fees collected by surgeons, anesthesiologists, medical specialty consultants, and consulting geriatricians and averaged $2024 per case. Thus, the average hospital charge to payers was $15?188. Compared to Agency for Healthcare Research and Quality average inpatient hospital costs in 2005 of $33?693, a savings of more than $18?000 was realized per patient. The average length of stay was 4.6 days, markedly less than the national average of 6.2 days. Conclusions: This organized geriatric fracture care model with geriatrics comanagement resulted in significant cost savings over a 50-month period, with associated increased quality. With an estimated 330?000 hip fractures annually in the United States, a large cost savings could potentially be realized if this model were more widely applied.