By Dawn Bowden
With an increasingly aging population, hip fractures are on the rise. More than 300,000 hip fractures occur annually,, and this number is expected to exceed 500,000 by 2040. Ninety percent of hip fractures occur in people older than age 65, who may already have significant co-morbidities when they arrive at hospital. Hip fractures are generally associated with chronic pain, reduced mobility, disability, and an increasing degree of dependence.Research suggests that only 50 percent of hip fracture patients return to their previous mobility levels prior to injury within one year after fracture. Further, one-year mortality rate is estimated between 17 and 27 percent. The economic burden of managing hip fractures was estimated at $17 to $20 billion in 2010.
From increased mortality rates and decreased mobility to an immense economic burden, hip fractures are serious life-changing events and have a major impact on health systems and the patients they serve. The University of Maryland Upper Chesapeake Health (UM UCH) sees an average of 200 acute hip fractures each year and nearly 90 percent require surgical intervention. Improving outcomes for this patient population has been a priority for UM UCH. UM UCH recognized the opportunity to change the trajectory of health outcomes for elderly hip fracture patients and find ways to deliver more organized and standardized care centered around the unique needs of these patients. Through its engagement with the Johnson & Johnson Medical Devices Companies (JJMDC), UM UCH has begun to realize some notable results in hip fracture care.
JJMDC assessed UM UCH’s hip fracture care approach and with the help of JJMDC, UM UCH implemented an evidence-based care improvement program focused on reducing variability, enhancing and standardizing interdisciplinary care, and improving patient outcomes. The Hip Fracture Care Program* offered by JJMDC is specifically designed for elderly hip fracture patients, a population that might arrive at the hospital with unrelated complications, such as diabetes or heart failure.
Through a needs assessment process, UM UCH shared its goals and challenges in serving hip fracture patients. JJMDC used those insights and designed a study to identify specific areas of improvement. The study looked at average time between admission and surgery, overall average length of stay, and 30-day all-cause readmission rate.
Within the first eight months, UM UCH gained valuable insights and began to realize significant improvements in its hip fracture patient care outcomesix:
- 63% reduction in 30-day patient readmission rate, from 12.4% to 4.6%**
- 17% decrease in average time between admission and surgery, from 30.4 to 25.1 hours**
- 14% reduction in average length of stay, from 5.7 to 4.9 days**
The evidence-based best practices and the strong collaboration between the two organizations enabled UM UCH to help more patients return to their previous function, ultimately decreasing mortality and morbidity in this predominately elderly and more fragile population. For example, for the first six months of the program, the one-year all-cause mortality rate dropped from 24 percent in 2015 to 16 percent based on a qualitative review of patient records.
As a result, UM UCH is in a better position to serve hip fracture patients more effectively and deliver value-based quality care to these patients. Further, the program UM UCH developed and implemented was recognized by the Maryland Patient Safety Center’s 2018 Annual Minogue Award for Patient Safety Innovation Call for Solutions and was as a “Circle of Honor” recipient for its positive impact on patient care.
With 20 years of medical leadership experience in the healthcare industry, Dawn E. Bowden serves as the Director for Strategic Alliances and Research Collaboration within the Health Economics and Market Access team for the Johnson & Johnson Medical Devices Companies (JJMDC), working with hospital systems and payers on value-based health care, quality improvement projects, health policy, data analytics, and real-world evidence (RWE) generation. She holds a Ph.D. from the International School of Management in Paris, France where her work focused on innovation and integration within health care systems. She is a member of the Association of Strategic Alliance Professionals (ASAP) and the International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
*Hip Fracture Care is a fee-for-service offering.
**All p values are <0.05