Value based health care for the frail elderly patient with a hip fracture

Abstract

Introduction: Based on the research of professor Porter Harvard value-based Health care is a framework for restructuring health cate systems with the overarching goal of value for patients – not access, cost-containment, convenience or customer service. It is outcome based. The International center of health outcomes ICHOM is a leading initiative for constructing evidence based methods to evaluate patient based outcomes. Practice change: In the region of our hospital we decided to put this into practice for elderly patients with a hip-fracture. There is no ICHOM program for elderly patients with hip-fractures so we concentrated on the program for frail elderly in combination with the Dutch hip-fracture audit. Based on these values we analyzed data from previous years and contracted “mirror-talks” with patients and their caregivers. Targeted population: frail elderly patients with a hip fracture Aim and theory: We divided the hip-fracture pathway into 3 major steps 1- The patient before the fracture, vulnerable at home or in the nursing home with all kind of problems e.g. polypharmacy, comorbidity, cognitive disorders, and ADL dysfunction and unknown wishes regarding to treatment restrictions and rehabilitations institutions. We developed a leaflet for all the frail elderly in our region to store at home. 2- Intra hospital: from the ambulance, to 3- The start of rehabilitation in a center or at home. Highlights and timeline: From this information we used 6 values for outcome improvement for the coming 12 months; mortality, morbidity, delirium, length and costs of hospital stay, length and costs of rehabilitation, and patients experience and satisfaction. The first results will be presented at the congress.