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Carney MT, Kwiatek S, Burns EA. Transforming health care: A large health organizations' journey to become an age-friendly health system (AFHS) and beyond. J Am Geriatr Soc 2024; 72:579-588. [PMID: 37927247 DOI: 10.1111/jgs.18646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/27/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND In 2017, the John A. Hartford Foundation partnered with the Institute for Health Care Improvement, American Hospital Association, and Catholic Health Care Organization to define the 4Ms framework to improve quality of care and health outcomes for older adults. The senior leadership of one of the largest integrated healthcare organizations (HCO) in the country recognized the relevance of these recommendations to the aging demographic of the United States. The health system provides care to over 2,000,000 unique patients annually, about 20% of whom are aged ≥65. We describe how commitment to becoming an Age-Friendly Health System (AFHS) has taken this HCO beyond the targets set by the initiative. METHODS Steps guiding evolution of the AFHS model of care are as follows: Initiation, assessment, planning, implementation, sustainability. An AFHS leadership team including geriatrics and quality improvement expertise oversees the initiative. Plan-Do-Study-Act cycles are utilized at multiple stages to develop structures for data collection and reporting outcomes. RESULTS Initiation and assessment stages identified key champions and existing efforts and programs that were leveraged to implement 4Ms best practices. Working committees with relevant expertise for each M selected evidence-based quality measures and designed/adapted training materials. The EHR is used to integrate quality measures and gather outcome data to inform changes in care. Dashboards capturing quality measures for each M have been implemented and pilot-tested at a community-based hospital and these processes are being adapted and disseminated to other settings. Leadership and stakeholders convene regularly to review lessons learned and next steps. CONCLUSIONS On the health system level, partnering with quality management leaders has led to development of processes that feed into organizational level data used to track longitudinal improvements in patient outcomes. Outcome data in each of the 4M domains are presented. Learning points are shared to help others take a systems-approach to age-friendly change.
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Affiliation(s)
- Maria Torroella Carney
- Geriatrics and Palliative Medicine, Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
- Geriatrics and Palliative Medicine, Northwell Health, Manhasset, New York, USA
| | - Susan Kwiatek
- Geriatrics and Palliative Medicine, Northwell Health, Manhasset, New York, USA
| | - Edith A Burns
- Geriatrics and Palliative Medicine, Zucker School of Medicine at Hofstra Northwell, Hempstead, New York, USA
- Geriatrics and Palliative Medicine, Northwell Health, Manhasset, New York, USA
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Gupta S, Walke L, Simone M, Michener A, Nembhard I. The perceived value of a geriatrics-surgery co-management program: Perspectives from three surgical specialties. J Am Geriatr Soc 2024; 72:48-58. [PMID: 37947016 DOI: 10.1111/jgs.18636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/16/2023] [Accepted: 09/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Geriatrics-surgery co-management (GSCM) programs have improved patient outcomes, but little is known about how they change care and whether their value varies by surgical specialty. We aimed to assess GSCM's effects as perceived by Orthopedic Trauma, Trauma, and Neurosurgery clinicians. METHODS We conducted a mixed-methods study utilizing electronic survey and virtual interviews at Penn Presbyterian Medical Center, an academic trauma center, in Philadelphia, PA. Participants included physicians, advanced practice providers, nurses, social workers, and case managers in the aforementioned specialties. Key measures were perspectives on value of GSCM, its facilitators, specialty most appropriate to manage specified medical issues, and factors affecting use. RESULTS Of 71 eligible clinicians, 45 (63%) completed the survey and 12 (21%) of 56 purposefully sampled for specialty-role diversity were interviewed. Clinicians across specialties valued GSCM highly and similarly for impact on personal management of older adults (grand mean [standard error, SE] = 4.33 [0.24] out of 5; p = 0.80 for specialty means comparisons), patient care (mean [SE] = 4.47 [0.21]; p = 0.27), patient outcomes (mean [SE] = 4.26 [0.22]; p = 0.51), and specialty overall (mean [SE] = 4.55 [0.23]; p = 0.25) but less so for knowledge growth (mean [SE] = 3.47 [0.29]; p = 0.11). Interviewees across specialties reported that value derived from improved understanding of patient history, management of complex medical conditions, goals of care support, communication with families, and patient discharge facilitation. Interviewees also agreed on program facilitators: aligned stakeholders, shared data-driven goals, champion/administrative support, continuity and availability of geriatricians, and thorough communication. Specialties differed on three issues: (1) who should manage some medical concerns; (2) whether GSCM makes their job easier (significantly easier for Orthopedic Trauma: mean [SE] = 4.75 [0.29] vs. Trauma: mean [SE] = 4.01 [0.19]; p = 0.05); and (3) whether GSCM increases coordination difficulty (more for Neurosurgery: mean [SE] = 2.18 [0.0.58] vs. Orthopedic Trauma: mean [SE] = 0.51 [0.42]; p = 0.03 and Trauma: mean [SE] = 0.89 [0.28]; p = 0.07). Orthopedic Trauma had the most positive impression of GSCM overall. CONCLUSIONS Clinicians across diverse surgical specialties valued GSCM. Hospitals considering implementation or expansion of GSCM should attend to identified facilitators and may need to tailor to specialty.
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Affiliation(s)
- Sonia Gupta
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Walke
- Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark Simone
- Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alyson Michener
- Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ingrid Nembhard
- The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Fernando M, Abell B, Tyack Z, Donovan T, McPhail SM, Naicker S. Using Theories, Models, and Frameworks to Inform Implementation Cycles of Computerized Clinical Decision Support Systems in Tertiary Health Care Settings: Scoping Review. J Med Internet Res 2023; 25:e45163. [PMID: 37851492 PMCID: PMC10620641 DOI: 10.2196/45163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 08/18/2023] [Accepted: 09/14/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Computerized clinical decision support systems (CDSSs) are essential components of modern health system service delivery, particularly within acute care settings such as hospitals. Theories, models, and frameworks may assist in facilitating the implementation processes associated with CDSS innovation and its use within these care settings. These processes include context assessments to identify key determinants, implementation plans for adoption, promoting ongoing uptake, adherence, and long-term evaluation. However, there has been no prior review synthesizing the literature regarding the theories, models, and frameworks that have informed the implementation and adoption of CDSSs within hospitals. OBJECTIVE This scoping review aims to identify the theory, model, and framework approaches that have been used to facilitate the implementation and adoption of CDSSs in tertiary health care settings, including hospitals. The rationales reported for selecting these approaches, including the limitations and strengths, are described. METHODS A total of 5 electronic databases were searched (CINAHL via EBSCOhost, PubMed, Scopus, PsycINFO, and Embase) to identify studies that implemented or adopted a CDSS in a tertiary health care setting using an implementation theory, model, or framework. No date or language limits were applied. A narrative synthesis was conducted using full-text publications and abstracts. Implementation phases were classified according to the "Active Implementation Framework stages": exploration (feasibility and organizational readiness), installation (organizational preparation), initial implementation (initiating implementation, ie, training), full implementation (sustainment), and nontranslational effectiveness studies. RESULTS A total of 81 records (42 full text and 39 abstracts) were included. Full-text studies and abstracts are reported separately. For full-text studies, models (18/42, 43%), followed by determinants frameworks (14/42,33%), were most frequently used to guide adoption and evaluation strategies. Most studies (36/42, 86%) did not list the limitations associated with applying a specific theory, model, or framework. CONCLUSIONS Models and related quality improvement methods were most frequently used to inform CDSS adoption. Models were not typically combined with each other or with theory to inform full-cycle implementation strategies. The findings highlight a gap in the application of implementation methods including theories, models, and frameworks to facilitate full-cycle implementation strategies for hospital CDSSs.
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Affiliation(s)
- Manasha Fernando
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Bridget Abell
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Zephanie Tyack
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Thomasina Donovan
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- Digital Health and Informatics Directorate, Metro South Health, Brisbane, Australia
| | - Sundresan Naicker
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
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Schloemann DT, Ricciardi BF, Thirukumaran CP. Disparities in the Epidemiology and Management of Fragility Hip Fractures. Curr Osteoporos Rep 2023; 21:567-577. [PMID: 37358663 DOI: 10.1007/s11914-023-00806-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to synthesize the recently published scientific evidence on disparities in epidemiology and management of fragility hip fractures. RECENT FINDINGS There have been a number of investigations focusing on the presence of disparities in the epidemiology and management of fragility hip fractures. Race-, sex-, geographic-, socioeconomic-, and comorbidity-based disparities have been the primary focus of these investigations. Comparatively fewer studies have focused on why these disparities may exist and interventions to reduce disparities. There are widespread and profound disparities in the epidemiology and management of fragility hip fractures. More studies are needed to understand why these disparities exist and how they can be addressed.
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Affiliation(s)
- Derek T Schloemann
- Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Benjamin F Ricciardi
- Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA
| | - Caroline P Thirukumaran
- Department of Orthopaedics and Physical Performance, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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Shen JY, Mendelson DA, Lang VJ. Transforming an Orthopaedic Unit Into an "Age-Friendly" Unit Through Implementation of the American Geriatrics Society's CoCare: Ortho Program. J Orthop Trauma 2022; 36:e182-e188. [PMID: 34629392 DOI: 10.1097/bot.0000000000002279] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To transform an inpatient orthopaedic unit into an age-friendly unit for geriatric fracture center (GFC) patients. DESIGN Pragmatic dissemination study of a continuous quality improvement intervention with episodic data review. SETTING Large quaternary care university hospital with no on-site geriatrics program and no dedicated geriatric inpatient unit. PARTICIPANTS Individuals 60 years of age and older with fragility fracture of the native proximal femur hospitalized from July 2017 to June 2020. INTERVENTION A hospital medicine-orthopaedics comanagement model for a GFC was developed using processes, tools, and education provided by the American Geriatrics Society's AGS CoCare: Ortho program to support the age-friendly 4Ms principles: mentation, mobility, medications, and what matters. Delirium reduction strategies included minimizing sleep interruption through changes in blood draw times, order sets for pain management, and nursing education. Mobility specialists were incorporated to improve early mobilization on the orthopaedic unit. MAIN OUTCOME MEASUREMENTS Frequency of weight-bearing on postoperative day 1 and frequency of delirium among GFC patients on the orthopaedic unit were compared with those among concurrent GFC patients on other units. RESULTS Frequency of delirium was 26% among patients on the orthopaedic unit versus 35% among those on other units (P = 0.055). Frequency of weight-bearing on post-operative day 1 was 84% among patients on the orthopaedic unit versus 72% among those on other units (P = 0.003). CONCLUSIONS AGS CoCare: Ortho is an effective dissemination program for establishing a hospital medicine-orthopaedics comanagement program and making an orthopaedic unit age-friendly in a hospital without onsite geriatricians or a dedicated geriatrics unit. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jenny Y Shen
- Hospital Medicine Division, Department of Medicine, Strong Memorial Hospital, University of Rochester, Rochester, NY; and
| | - Daniel Ari Mendelson
- Division of Geriatrics, Department of Medicine, Highland Hospital, University of Rochester, Rochester, NY
| | - Valerie J Lang
- Hospital Medicine Division, Department of Medicine, Strong Memorial Hospital, University of Rochester, Rochester, NY; and
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Bub C, Stapleton E, Iturriaga C, Garbarino L, Aziz H, Wei N, Mota F, Goldin ME, Sinvani LD, Carney MT, Goldman A. Implementation of a Geriatrics-Focused Orthopaedic and Hospitalist Fracture Program Decreases Perioperative Complications and Improves Resource Utilization. J Orthop Trauma 2022; 36:213-217. [PMID: 34483320 DOI: 10.1097/bot.0000000000002258] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate whether the implementation of a geriatrics-focused orthopaedic and hospitalist comanagement program can improve perioperative outcomes and decrease resource utilization. DESIGN A retrospective chart review study was conducted before and after the implementation of a geriatrics-focused orthopaedic and hospitalist comanagement program, based on the American Geriatrics Society (AGS) AGS CoCare:Ortho. SETTING A large urban, academic tertiary center, located in the greater New York metropolitan area. PARTICIPANTS Patients 65 years and older hospitalized for operative hip fracture. Those with pathologic or periprosthetic fractures and chronic substance use were excluded. MAIN OUTCOME MEASUREMENTS Outcome measures included time to operating room (TtOR), length of stay, daily and total morphine milligram equivalents, use of preoperative transthoracic echocardiogram and blood transfusions, perioperative complications (eg, urinary tract infections), and 6-month mortality. RESULTS Our study included 290 patients hospitalized with hip fracture, before (N = 128) and after (N = 162) implementation. When compared with the preimplementation group, the postimplementation comanagement group had a lower TtOR (36.2 vs. 30.0 hours, P = 0.026) and hospital length of stay, decreased use of indwelling bladder catheters preoperatively and postoperatively (68.0% vs. 46.9%, P < 0.001, and 83.6 vs. 58.0%, P < 0.001, respectively), reduced daily opiate use (16.0 vs. 11.1 morphine milligram equivalents, P = 0.011), and decreased 30-day complications (32.8% vs. 16.7%, P = 0.002). There was no difference in 6-month mortality between the 2 groups. CONCLUSIONS The implementation of an AGS CoCare:Ortho-based comanagement program led to decreased perioperative complications and resource utilization. Comanagement programs are essential to improving and standardizing hip fracture care for older adults. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christine Bub
- Zucker School of Medicine at Hofstra/Northwell, Department of Orthopaedic Surgery, Long Island Jewish Hospital, Northwell Health, Great Neck, NY
| | - Erik Stapleton
- Zucker School of Medicine at Hofstra/Northwell, Department of Orthopaedic Surgery, Plainview Hospital, Plainview, NY
| | - Cesar Iturriaga
- Zucker School of Medicine at Hofstra/Northwell, Department of Orthopaedic Surgery, Long Island Jewish Hospital, Northwell Health, Great Neck, NY
| | - Luke Garbarino
- Zucker School of Medicine at Hofstra/Northwell, Department of Orthopaedic Surgery, Long Island Jewish Hospital, Northwell Health, Great Neck, NY
| | - Hadi Aziz
- Sophie Davis Biomedical Education/CUNY School of Medicine, New York, NY
| | - Nicole Wei
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX
| | - Frank Mota
- Zucker School of Medicine at Hofstra/Northwell, Department of Orthopaedic Surgery, Lennox Hill Hospital, New York, NY; and
| | - Mark Eliot Goldin
- Zucker School of Medicine at Hofstra/Northwell, Department of Medicine, Long Island Jewish Hospital, Northwell Health, Great Neck, NY
| | - Liron Danay Sinvani
- Zucker School of Medicine at Hofstra/Northwell, Department of Medicine, Long Island Jewish Hospital, Northwell Health, Great Neck, NY
| | - Maria Torroella Carney
- Zucker School of Medicine at Hofstra/Northwell, Department of Medicine, Long Island Jewish Hospital, Northwell Health, Great Neck, NY
| | - Ariel Goldman
- Zucker School of Medicine at Hofstra/Northwell, Department of Orthopaedic Surgery, Long Island Jewish Hospital, Northwell Health, Great Neck, NY
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Kotsani M, Kravvariti E, Avgerinou C, Panagiotakis S, Bograkou Tzanetakou K, Antoniadou E, Karamanof G, Karampeazis A, Koutsouri A, Panagiotopoulou K, Soulis G, Stolakis K, Georgiopoulos I, Benetos A. The Relevance and Added Value of Geriatric Medicine (GM): Introducing GM to Non-Geriatricians. J Clin Med 2021; 10:3018. [PMID: 34300184 PMCID: PMC8304813 DOI: 10.3390/jcm10143018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/28/2021] [Accepted: 07/02/2021] [Indexed: 11/23/2022] Open
Abstract
Geriatric Medicine (GM) holds a crucial role in promoting health and managing the complex medical, cognitive, social, and psychological issues of older people. However, basic principles of GM, essential for optimizing the care of older people, are commonly unknown or undermined, especially in countries where GM is still under development. This narrative review aims at providing insights into the role of GM to non-geriatrician readers and summarizing the main aspects of the added value of a geriatric approach across the spectrum of healthcare. Health practitioners of all specialties are frequently encountered with clinical conditions, common in older patients (such as cancer, hypertension, delirium, major neurocognitive and mental health disorders, malnutrition, and peri-operative complications), which could be more appropriately managed under the light of the approach of GM. The role of allied health professionals with specialized knowledge and skills in dealing with older people's issues is essential, and a multidisciplinary team is required for the delivery of optimal care in response to the needs and aspirations of older people. Thus, countries should assure the educational background of all health care providers and the specialized health and social care services required to meet the demands of a rapidly aging society.
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Affiliation(s)
- Marina Kotsani
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Geriatrics, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France
- FHU CARTAGE-PROFILES, Université de Lorraine, 54505 Vandœuvre-lès-Nancy, France
| | - Evrydiki Kravvariti
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- 1st Department of Propaedeutic Internal Medicine, Laiko General Hospital, 11527 Athens, Greece
- Postgraduate Medical Studies in the Physiology of Aging and Geriatric Syndromes, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Christina Avgerinou
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Symeon Panagiotakis
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Internal Medicine, Heraklion University Hospital, 71003 Heraklion, Greece
| | - Katerina Bograkou Tzanetakou
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Medical Psychology Unit, School of Medicine, European University Cyprus, 1516 Nicosia, Cyprus
| | - Eleftheria Antoniadou
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Rehabilitation Unit, Patras University Hospital, 26504 Rio, Greece
| | - Georgios Karamanof
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Geriatric Clinic, Vrinnevi Hospital, 60379 Norrköping, Sweden
| | - Athanasios Karampeazis
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Medical Oncology Unit, NIMTS Veterans Hospital, 11521 Athens, Greece
| | - Anastasia Koutsouri
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Henry Dunant Hospital Center, Outpatient Geriatric Assessment Unit, 11526 Athens, Greece
| | - Kyriaki Panagiotopoulou
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Geriatric Ward, Hôpital “Sainte Thérèse”, VIVALIA-IFAC, 6600 Bastogne, Belgium
| | - George Soulis
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Henry Dunant Hospital Center, Outpatient Geriatric Assessment Unit, 11526 Athens, Greece
- School of Social Sciences, Hellenic Open University, 26335 Patras, Greece
| | - Konstantinos Stolakis
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- School of Medicine, Patras University, 26504 Rio, Greece
| | - Ioannis Georgiopoulos
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Geriatrics, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France
- FHU CARTAGE-PROFILES, Université de Lorraine, 54505 Vandœuvre-lès-Nancy, France
| | - Athanase Benetos
- Working Group on the Development of Geriatric Medicine in Greece of the Hellenic Society for the Study and Research of Aging, 15342 Athens, Greece; (E.K.); (C.A.); (S.P.); (K.B.T.); (E.A.); (G.K.); (A.K.); (A.K.); (K.P.); (G.S.); (K.S.); (I.G.); (A.B.)
- Department of Geriatrics, CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France
- FHU CARTAGE-PROFILES, Université de Lorraine, 54505 Vandœuvre-lès-Nancy, France
- INSERM DCAC, 54505 Vandœuvre-lès-Nancy, France
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Zhong H, Poeran J, Liu J, Wilson LA, Memtsoudis SG. Hip fracture characteristics and outcomes during COVID-19: a large retrospective national database review. Br J Anaesth 2021; 127:15-22. [PMID: 33965205 PMCID: PMC8049451 DOI: 10.1016/j.bja.2021.04.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 12/22/2022] Open
Abstract
Background The COVID-19 pandemic has impacted healthcare in various vulnerable patient subpopulations. However, data are lacking on the impact of COVID-19 on hip fractures, seen mainly in older patients. Using national claims data, we aimed to describe the epidemiology during the first COVID-19 wave in the USA. Methods We compared patients admitted for hip fractures during March and April of 2020 with those admitted in 2019 in terms of patient and healthcare characteristics, COVID-19 diagnosis, and outcomes. An additional comparison was made between COVID-19-positive and -negative patients. Outcomes included length of hospital stay (LOS), admission to an ICU, ICU LOS, use of mechanical ventilation, 30-day readmission, discharge disposition, and a composite variable of postoperative complications. Results Overall, 16 068 hip fractures were observed in 2019 compared with 7498 in 2020. Patients with hip fractures in 2020 (compared with 2019) experienced earlier hospital discharge and were less likely to be admitted to ICU, but more likely to be admitted to home. Amongst 83 patients with hip fractures with concomitant COVID-19 diagnosis, we specifically observed more non-surgical treatments, almost doubled LOS, a more than 10-fold increased mortality rate, and higher complication rates compared with COVID-19-negative patients. Conclusions The COVID-19 pandemic significantly impacted not only volume of hip fractures, but also patterns in care and outcomes. These results may inform policymakers in future outbreaks and how this may affect vulnerable patient populations, such as those experiencing a hip fracture.
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Affiliation(s)
- Haoyan Zhong
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Jashvant Poeran
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Lauren A Wilson
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Stavros G Memtsoudis
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria; Department of Health Policy and Research, Weill Cornell Medical College, New York, NY, USA.
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9
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Gosch M, Kammerlander C, Fantin E, Jensen TG, Salazar AML, Olarte C, Bavatonavarech S, Medina C, Link BC, Cunningham M. Design and Evaluation of a Hospital-Based Educational Event on Fracture Care for Older Adult. Geriatr Orthop Surg Rehabil 2021; 12:21514593211003857. [PMID: 33868767 PMCID: PMC8020218 DOI: 10.1177/21514593211003857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Surgeons, internal medicine physicians, nurses, and other members of the
healthcare team managing older adults with a fracture all have barriers to
attending educational courses, including time away from practice and cost.
Our planning group decided to create and evaluate a hospital-based
educational event to address, meet, and improve the care of older adults
with a fracture. Materials and Methods: A committee of surgeons and geriatricians defined 3 learning objectives to
improve knowledge and attitudes in co-managed care. They designed a 1-day
educational event consisting of a departmental visit, a review of cases, a
planning session to identify gaps and plan changes, and presentations on
selected topics. Thirteen hospitals worldwide completed an 8-question online
application form, and 7 sites were selected for delivery over 3 years in
Denmark, Colombia, Thailand, Paraguay, Switzerland, and the Dominican
Republic. Results: Each event was conducted by 1 or more visiting surgeons and geriatricians,
and the local team leaders. The most common challenges reported in the
applications were preoperative assessment or optimization, delayed surgery,
lack of protocols, access to a geriatrician, teamwork, and specific aspects
of perioperative and postoperative care. In each department, 4 or 5 goals
and targets for implementation were agreed. The presentations section was
customized and attended by 20 to 50 team members. Discussion: Topics selected by a majority of departments were principles of co-managed
care (7), preoperative optimization (7), and management of delirium (4).
Follow up was conducted after 3 and 12 months to review the degree of
achievement of each planned change and to identify any barriers to complete
implementation. Conclusions: Hospital-based events with visiting and local faculty were effective to
engage a broader audience that might not attend external courses. A
performance improvement component with goal setting and follow up was
acceptable to all host departments.
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Affiliation(s)
| | | | - Emilio Fantin
- IMC Instituto Modelo de Cardiologia Cordoba, Argentina
| | | | | | | | | | - Claudia Medina
- IPS Universitaria Clínica León XIII, Envigado, Antioquia, Colombia
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10
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Van Grootven B, Jeuris A, Jonckers M, Devriendt E, Dierckx de Casterlé B, Dubois C, Fagard K, Herregods MC, Hornikx M, Meuris B, Rex S, Tournoy J, Milisen K, Flamaing J, Deschodt M. Geriatric co-management for cardiology patients in the hospital: A quasi-experimental study. J Am Geriatr Soc 2021; 69:1377-1387. [PMID: 33730373 DOI: 10.1111/jgs.17093] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/03/2021] [Accepted: 02/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND/OBJECTIVES Older patients admitted to cardiac care units often suffer functional decline. We evaluated whether a nurse-led geriatric co-management program leads to better functional status at hospital discharge. DESIGN A quasi-experimental before-and-after study was performed between September 2016 and December 2018, with the main endpoint at hospital discharge and follow-up at 6 months. SETTING Two cardiac care units of the University Hospitals Leuven. PARTICIPANTS One hundred and fifty-one intervention and 158 control patients aged 75 years or older admitted for acute cardiovascular disease or transcatheter aortic valve implantation. INTERVENTION A nurse from the geriatrics department performed a comprehensive geriatric assessment within 24 h of admission. The cardiac care team and geriatrics nurse drafted an interdisciplinary care plan, focusing on early rehabilitation, discharge planning, promoting physical activity, and preventing geriatric syndromes. The geriatrics nurse provided daily follow-up and coached the cardiac team. A geriatrician co-managed patients with complications. MEASUREMENTS The primary outcome was functional status measured using the Katz Index for independence in activities of daily living (ADL; one-point difference was considered clinically relevant). Secondary outcomes included the incidence of ADL decline and complications, length of stay, unplanned readmissions, survival, and quality of life. RESULTS The mean age of patients was 85 years. Intervention patients had better functional status at hospital discharge (8.9, 95% CI = 8.7-9.3 versus 9.5, 95% CI = 9.2-9.9; p = 0.019) and experienced 18% less functional decline during hospitalization (25% vs. 43%, p = 0.006). The intervention group experienced significantly fewer cases of delirium and obstipation during hospitalization, and significantly fewer nosocomial infections. At 6-month follow-up, patients had significantly better functional status and quality of life. There were no differences regarding length of stay, readmissions, or survival. CONCLUSION This first nurse-led geriatric co-management program for frail patients on cardiac care units was not effective in improving functional status, but significantly improved secondary outcomes.
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Affiliation(s)
- Bastiaan Van Grootven
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Anthony Jeuris
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Maren Jonckers
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Els Devriendt
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Christophe Dubois
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Katleen Fagard
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Marie-Christine Herregods
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Miek Hornikx
- Department of Rehabilitation Sciences, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meuris
- Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Steffen Rex
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Anaesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Jos Tournoy
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Mieke Deschodt
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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11
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Mi B, Chen L, Tong D, Panayi AC, Ji F, Guo J, Ou Z, Zhang Y, Xiong Y, Liu G. Delayed surgery versus nonoperative treatment for hip fractures in post-COVID-19 arena: a retrospective study of 145 patients. Acta Orthop 2020; 91:639-643. [PMID: 32896189 PMCID: PMC8023940 DOI: 10.1080/17453674.2020.1816617] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Following the outbreak of COVID-19 in December 2019, in China, many hip fracture patients were unable to gain timely admission and surgery. We assessed whether delayed surgery improves hip joint function and reduces major complications better than nonoperative therapy. Patients and methods - In this retrospective observational study, we collected data from 24 different hospitals from January 1, 2020, to July 20, 2020. 145 patients with hip fractures aged 65 years or older were eligible. Clinical data was extracted from electronic medical records. The primary outcomes were visual analogue scale (VAS) score and Harris Hip Score. Major complications, including deep venous thrombosis (DVT) and pneumonia within 1 month and 3 months, were collected for further analysis. Results - Of the 145 hip fracture patients 108 (median age 72; 70 females) received delayed surgery and 37 (median age 74; 20 females) received nonoperative therapy. The median time from hip fracture injury to surgery was 33 days (IQR 24-48) in the delayed surgery group. Hypertension, in about half of the patients in both groups, and cerebral infarction, in around a quarter of patients in both groups, were the most common comorbidities. Both VAS score and Harris Hip Score were superior in the delayed surgery group. At the 3-month follow-up, the median VAS score was 1 in the delayed surgery group and 2.5 in the nonoperative group (p < 0.001). Also, the percentage of complications was higher in the nonoperative group (p = 0.004 for DVT, p < 0.001 for pulmonary infection). Interpretation - In hip fracture patients, delayed surgery compared with nonoperative therapy significantly improved hip function and reduced various major complications.
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Affiliation(s)
- Bobin Mi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;
| | - Lang Chen
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;
| | - Dake Tong
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China;
| | - Adriana C Panayi
- Department of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical College, Boston, USA;
| | - Fang Ji
- Department of Orthopedics, Changhai Hospital, Shanghai, China;
| | - Junfei Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiyong Ou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuan Xiong
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China;
| | - Guohui Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; ,Correspondence:
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