The Case for Comanagement and Care Pathways for Osteoporotic Patients with a Hip Fracture.

Abstract

* Rapid preoperative evaluation and clearance is an essential component of hip fracture care. Evidence-based guidelines should be used to reduce unnecessary testing and minimize delays.* Current practice guidelines recommend surgery within 24 to 48 hours of presentation, and a well-designed pathway can typically facilitate rapid surgery for all but the most medically unstable patients.* Institutionalized initiation of osteoporosis management in patients with a hip fracture improves patient outcomes and is cost-effective but must overcome multiple barriers. Several pragmatic programs have been developed to help orthopaedic surgeons facilitate this process.* Comanagement services need substantial work to establish, require teamwork among multiple engaged teams, and should create a culture of continuous process improvement.* When implemented successfully, comanagement services with dedicated care pathways can improve outcomes, reduce complications, streamline care, and result in cost savings.