{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T01:08:03Z","timestamp":1769735283086,"version":"3.49.0"},"reference-count":25,"publisher":"Wiley","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Hosp Med"],"published-print":{"date-parts":[[2020,8,1]]},"abstract":"<jats:p>BACKGROUND: Hip fractures are a significant cause of morbidity and mortality among elderly patients. Coordinated multidisciplinary care is required to optimize medical outcomes.\nOBJECTIVE: To determine the effect of the implementation of standardized, evidence-based protocols on clinical outcomes and mortality in patients with fragility hip fractures.\nINTERVENTIONS: A multidisciplinary group was convened to define best practices in fragility hip fracture care and implement a fragility hip fracture clinical protocol at Yale-New Haven Hospital. Clinical outcomes in 2015, prior to program initiation, were compared with 2018, after the program was well established.\nMAIN OUTCOMES AND MEASURES: Measured outcomes included 30-day mortality, blood transfusion utilization, adverse effects of drugs, venous thromboembolic complications, sepsis, myocardial infarction, mechanical surgical fixation complications during the index admission, length of stay, 30-day readmission, unexpected return to the operating room (OR) and time to the OR.\nRESULTS: The implementation of the Integrated Fragility Hip Fracture Program was associated with significant reductions in 30-day mortality from 8.0% in 2015 to 2.8% in 2018 (P = .001). Significant reductions were also seen in use of blood transfusions (46.6% to 28.1%; P &lt; .001), adverse effects of drugs (4.0% to 0%; P &lt; .001), length of stay (5.12 to 4.47 days; P = .004), unexpected return to the OR (5.1% to 0%; P &lt; .001), and time to the OR &lt;24 hours (41.8% to 55.0%, P = .001). CONCLUSIONS: An Integrated Fragility Hip Fracture Program using multidisciplinary care, physician and nursing engagement, evidence-based protocols, data tracking with feedback, and accountability can reduce mortality and improve clinical outcomes in patients with hip fractures.<\/jats:p>","DOI":"10.12788\/jhm.3365","type":"journal-article","created":{"date-parts":[[2020,3,19]],"date-time":"2020-03-19T18:51:59Z","timestamp":1584643919000},"page":"461-467","source":"Crossref","is-referenced-by-count":16,"title":["Integrated Fragility Hip Fracture Program: A Model for High Quality Care"],"prefix":"10.1002","volume":"15","author":[{"given":"Jensa C","family":"Morris","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Moore","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Kahan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Shapiro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinlei","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brooke","family":"Spadaccino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Baumgaertner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,2,19]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"1. Abrahamsen B, van Staa T, Ariely M, Olson M, Cooper C. Excess mortality following hip fracture: a systematic epidemiologic review. Osteoporos Int. 2009;20(10):1633-1650. https:\/\/doi.org\/10.1007\/s00198-009-0920-3.","DOI":"10.1007\/s00198-009-0920-3"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"2. DellaRocca GJ, Moylan KC, Crist BD, Volgas DA, Stannard JP, Mehr DR. Comanagement of geriatric patients with hip fractures: a retrospective, controlled cohort study. Geriatr Orthop Surg Rehabil. 2013;4(1):10-15. https:\/\/doi.org\/10.1177\/2151458513495238.","DOI":"10.1177\/2151458513495238"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"3. Wang Y, Tang J, Zhou F, Yang L, Wu J. Comprehensive geriatric care reduces acute perioperative delirium in elderly patients with hip fractures: a meta-analysis. Medicine. 2017; 96(26): e7361. https:\/\/doi.org\/10.1097\/MD.0000000000007361.","DOI":"10.1097\/md.0000000000007361"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"4. Liu VX, Rosas E, Hwang J, et al. Enhanced recovery after surgery program implementation in 2 surgical populations in an integrated health care delivery system. JAMA Surg. 2017;152(7):e171032. https:\/\/doi.org\/10.1001\/jamasurg.2017.1032.","DOI":"10.1001\/jamasurg.2017.1032"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"5. Taraldsen K, Sletvold O, Thingstad P, et al. Physical behavior and function early after hip fracture surgery in patients receiving geriatric care or orthopedic care\u2014a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2014;69(3):338-345. https:\/\/doi.org\/10.1093\/gerona\/glt097.","DOI":"10.1093\/gerona\/glt097"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"6. Grimes JP, Gregory PM, Noveck H, Butler MS, Carson Jl. The effects of time-to-surgery on mortality and morbidity in patients following hip fracture. Am J Med. 2002;112(9):702-709. https:\/\/doi.org\/10.1016\/s0002-9343(02)01119-1.","DOI":"10.1016\/s0002-9343(02)01119-1"},{"key":"ref6","unstructured":"7. Hamlet WP, Lieberman JR, Freedman EL, Dorey FJ, Fletcher A, Johnson EE. Influence of health status and the timing of surgery on mortality in hip fracture patients. Am J Orthop. 1997;26(9):621-627."},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"8. Hoenig H, Rubenstein LV, Sloane R, Honer R, Kahn K. What is the role of timing in the surgical and rehabilitative care of community-dwelling older persons with acute hip fracture? Arch Intern Med. 1997;157(5):513-520.","DOI":"10.1001\/archinte.1997.00440260055009"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"9. Orosz GM, Magaziner J, Hannan El, et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA. 2004;291(14):1738-1743. https:\/\/doi.org\/10.1001\/jama.291.14.1738.","DOI":"10.1001\/jama.291.14.1738"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"10. Gdalevich M, Cohen D, Yosef D, Tauber C. Morbidity and mortality after hip fracture: the impact of operative delay. Arch Orthop Trauma Surg. 2004:124(5):334-340. https:\/\/doi.org\/10.1007\/s00402-004-0662-9.","DOI":"10.1007\/s00402-004-0662-9"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"11. Doruk H, Mas MR, Yidiz C, Sonmez A, K\u00fdrdemir V. The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly. Arch Gerontol Geriatr. 2004;39(2):179-185.https:\/\/doi.org\/10.1016\/j.archger.2004.03.004.","DOI":"10.1016\/j.archger.2004.03.004"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"12. Uzoigwe CE, Burnand HG, Cheesman CL, Aghedo DO, Faizi M, Middleton RG. Early and ultra-early surgery in hip fracture patients improves survival. Injury. 2013;44(6):726-729. https:\/\/doi.org\/10.1016\/j.injury.2012.08.025.","DOI":"10.1016\/j.injury.2012.08.025"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"13. Guay J, Parker MJ, Griffiths R, Kopp SL. Peripheral nerve blocks for hip fractures. Cochrane Database Syst Rev. 2017;5: CD001159. https:\/\/doi.org\/10.1002\/14651858.CD001159.pub2.","DOI":"10.1002\/14651858.cd001159.pub2"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"14. Morrison RS, Dickman E, Hwang U, et al. Regional nerve blocks improve pain and functional outcomes in hip fracture: a randomized controlled trial. J Am Geriatr Soc. 2016;64(12):2433-2439. https:\/\/doi.org\/10.1111\/jgs.14386.","DOI":"10.1111\/jgs.14386"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"15. Beaudoin FL, Haran JP, Liebmann O. A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in emergency deparment patients with hip fractures: a randomized controlled trial. Acad Emerg Med. 2013;20(6):584-591. https:\/\/doi.org\/10.1111\/acem.12154.","DOI":"10.1111\/acem.12154"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"16. Dickman E, Pushkar I, Likourezos A, et al. Ultrasound-guided nerve blocks for intracapsular and extracapsular hip fractures. Am J Emerg Med. 2016;34(3):586-589. https:\/\/doi.org\/10.1016\/j.ajem.2015.12.016.","DOI":"10.1016\/j.ajem.2016.05.041"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"17. Carson JL, Terrin MI, Noveck H, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011;365(26):2453-2462. https:\/\/doi.org\/10.1056\/NEJMoa1012452.","DOI":"10.1056\/nejmoa1012452"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"18. Garcia-Alvarez F, Al-Ghanem R, Garc\u00eda-Alvarez I, L\u00f3pez-Baisson A, Bernal M. Risk factors for postoperative infections in patients with hip fracture treated by means of Thompson arthoplasty. Arch Gerontol Geriatr. 2010; 50(1):51-55. https:\/\/doi.org\/10.1016\/j.archger.2009.01.009.","DOI":"10.1016\/j.archger.2009.01.009"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"19. Farrow LS, Smith TO, Ashcroft GP, Myint PK. A systematic review of tranexamic acid in hip fracture surgery. Br J Clin Pharmacol. 2016;82(6):1458-1470. https:\/\/doi.org\/10.1111\/bcp.13079.","DOI":"10.1111\/bcp.13079"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"20. Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e278S-e325S. https:\/\/doi.org\/10.1378\/chest.11-2404.","DOI":"10.1378\/chest.11-2404"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"21. Gillespie WJ, Walenkamp G. Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database Syst Rev. 2010;(3):CD000244. https:\/\/doi.org\/10.1002\/14651858.CD000244.pub2.","DOI":"10.1002\/14651858.cd000244"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"22. Kamel HK, Iqbal MA, Mogallapu R, Maas D, Hoffmann RG. Time to ambulation after hip fracture surgery: relation to hospitalization outcomes. J Gerontol A Biol Sci Med Sci. 2003;58(11):1042-1045. https:\/\/doi.org\/10.1093\/gerona\/58.11.m1042.","DOI":"10.1093\/gerona\/58.11.m1042"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"23. Foster MR, Heppenstall RB, Friedenberg ZB, Hozack WJ. A prospective assessment of nutritional status and complications in patients with fractures of the hip. J Orthop Trauma. 1990;4(1):49-57. https:\/\/doi.org\/10.1097\/00005131-199003000-00009.","DOI":"10.1097\/00005131-199003000-00009"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"24. Bell JJ, Pulle RC, Crouch AM, Kuys SS, Ferrier RL, Whitehouse SL. Impact of malnutrition on 12-month mortality following acute hip fracture. ANZ J Surg. 2016;86(3):157-161. https:\/\/doi.org\/10.1111\/ans.13429.","DOI":"10.1111\/ans.13429"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"25. Avenell A, Handoll HH. Nutritional supplementation for hip fracture aftercare in older people. Cochrane Database Syst Rev. 2010;(1):CD001880. https:\/\/doi.org\/10.1002\/14651858.CD001880.pub5.","DOI":"10.1002\/14651858.cd001880.pub5"}],"container-title":["Journal of Hospital Medicine"],"original-title":[],"link":[{"URL":"https:\/\/mdedge-files-live.s3.us-east-2.amazonaws.com\/files\/s3fs-public\/issues\/articles\/461_morris0506_0820.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,1]],"date-time":"2022-01-01T16:59:31Z","timestamp":1641056371000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.journalofhospitalmedicine.com\/jhospmed\/article\/217198\/hospital-medicine\/integrated-fragility-hip-fracture-program-model-high"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,19]]},"references-count":25,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2020,8,1]]}},"URL":"https:\/\/doi.org\/10.12788\/jhm.3365","relation":{},"ISSN":["1553-5606","1553-5592"],"issn-type":[{"value":"1553-5606","type":"electronic"},{"value":"1553-5592","type":"print"}],"subject":[],"published":{"date-parts":[[2020,2,19]]}}}