As we discussed in our recent Geriatrics Services Strategy webconference, hospitals can choose from a variety of programs—both formal and informal—to elevate specialized services for the elderly, improve outcomes, and improve margins. During the call, we received a question regarding geriatric fracture programs, and we wanted to provide more information here in follow-up.
Hospitals establish geriatric fracture programs to ensure that patients receive timely, high quality care for a range of fractures. Elderly patients commonly suffer from weakened (osteoporotic) bones, leaving them more frail and susceptible to a range of fractures, particularly hip fractures, but also arm, foot, etc. According to HCUP data, over half (54%) of patients receiving inpatient care for fractures are age 65 or older. Among hip fracture patients, the proportion that are elderly rises to 87%. Geriatric fracture programs bring together orthopedists, geriatricians, and other providers who specialize in treating fractures in elderly, frail patients. Clinical studies suggest that such collaboration may improve outcomes for fracture patients.
Highland Hospital, an affiliate of University of Rochester Medical Center, offers this type of geriatric fracture program. The Hospital’s Geriatric Fracture Center offers a facility “dedicated exclusively to the care of elderly patients who suffer fractures.” According to its website, the center partners with nursing homes and assisted living facilities to allow geriatric patients with fractures to be admitted directly to the center, bypassing the emergency department entirely. The center includes three operating rooms and strives to complete most surgeries within 24 hours, even on weekends.
Most fracture programs, though, don’t offer a dedicated space. For example, one Marketing and Planning Leadership Council member implementing a geriatric fracture program is relying on the American Orthopedic Association’s “Own the Bone” program. The quality improvement program focuses on fracture prevention through treatment of osteoporosis and secondary prevention of fractures. In implementing the "Own the Bone" program, the hospital is working closely with post-acute providers to ensure fracture patients receive adequate follow-up care.
The hospital’s efforts also include standardizing their trauma processes to reduce hip fracture patients’ wait time for surgery. Two of the hospital’s top hip fracture surgeons have led the standardization effort, which aligns with MPLC research in suggesting that successful service line standardization efforts are physician-led. Ultimately, the hospital hopes that its efforts to improve geriatric fracture care lead to increased volume growth, both for fracture-specific care as well as for other orthopedic procedures like hip replacement.
Other organizations have partnered with Synthes, a medical technology company that has developed pre-packaged resources for geriatric fracture program development. The Synthes Geriatric Fracture Program offers institutions “a project plan, sample protocols, and care plans,” as well as a database for tracking patient outcomes. The program encourages hospitals to streamline admissions to ensure that patients receive surgery within 24 hours and to create multidisciplinary collaboration between orthopedic surgeons and hospitalists and/or geriatricians.
The goal of geriatric fracture programs will be similar to that of other geriatric offerings: by standardizing care, hospitals hope to improve quality of care, reduce patient length of stay, increase patient satisfaction, and ultimately boost volume growth. Partnerships with physicians and nursing homes developed through a fracture program may lead to increased referrals. Though the costs of establishing a formalized fracture program might be relatively low, such an initiative isn’t a necessity for institutions. Rather, it is one of many options that hospitals might consider as they carefully develop a geriatric services strategy that prioritizes initiatives and allocates limited resources to improve care and lower costs for treating geriatric patients.
Our aforementioned Geriatric Services Strategy webconference provides a primer of options for best positioning geriatric services within an organizations’ broader strategy.