Association of comprehensive geriatric assessment with quality-related care practices during implementation and development of an orthogeriatric hip fracture program

Abstract

IntroductionThis study was performed to examine the association of a comprehensive geriatric assessment (CGA) with quality-related care practices during the implementation and development of an orthogeriatric hip fracture program. Materials and methodsPopulation-based, prospective data were collected on 1644 consecutive hip fracture patients aged≥65 years between September 2007 and December 2015. The outcome variables were delay from admission to surgery<24h, transfusion of red blood cells and removal of indwelling urinary catheter during the acute period of hospitalization. The adjustments used were age, sex, American Society of Anesthesiologists score, diagnosis of memory disease and prefracture living arrangements and mobility level. ResultsSince beginning the orthogeriatric program, performing the CGA (OR: 1.43, 95% CI 1.36–1.50), delay from admission to surgery<24h (OR: 1.06, 95% CI 1.02–1.11) and urinary catheter removal before discharge (OR: 1.51, 95% CI 1.43–1.58) increased significantly. In the adjusted analysis, interaction of CGA with follow-up time increased urinary catheter removal (OR: 10.0, 95% CI 7.34–13.7) and red blood cell transfusions (OR: 1.32, 95% CI 1.02–1.71), but had no effect on the delay to surgery (OR 1.07, 95% CI 0.83–1.38). ConclusionsImplementation of an orthogeriatric program led to several quality improvements: more patients received CGA, underwent surgery within 24h of admission, and had their urinary catheter removed during the acute period of hospitalisation. Administering the CGA was associated with prompt urinary catheter removal and increased red blood cell transfusions. The timing of surgery improved independent of the CGA.