Hip fracture in Auckland: contrasting models of care in two major hospitals

Abstract

The optimal setting and design of care for elderly patients with hip fracture is unknown. North Shore Hospital (NSH) and Middlemore Hospital (MMH) are two major hospitals in the Auckland region operating different models of orthogeriatric care. The aim of the study was to compare hip fracture care between NSH and MMH. A retrospective case record audit of patients aged 65 years and older with hip fracture from July to December 2004 at MMH and NSH was carried out. Charts for 203 patients (101 MMH and 102 NSH) were reviewed. The two groups were similar in age (mean age 83.2 years), sex (80% women) and other casemix factors. Median time from admission to theatre was shorter in NSH (21 vs 44 h, P < 0.0001). Length of stay was significantly shorter at NSH (mean difference 4.4 days, 95% confidence interval 1.1-7.6 when adjusted for casemix factors). Significantly more NSH patients were transferred for rehabilitation than MMH patients (75 vs 51%). At discharge, significantly more MMH patients (34 vs 14%) were treated with alendronate. Of 126 patients admitted from home, 81% returned home, 4% went to rest homes, 13% to private hospitals and 2% died; differences between centres were not significant. Overall inpatient mortality was 3.9%. The orthogeriatric model of care at NSH was associated with a shorter overall length of stay, earlier transfer to the Assessment, Treatment and Rehabilitation setting, and a higher proportion rehabilitated in Assessment, Treatment and Rehabilitation. Outcomes in terms of discharge destination and 6-month mortality were similar at both centres.