The Positive Effect of the Integrated Orthogeriatric Care Model on Quality Indicators Pre- and Post-operatively for Hip Fracture Patients 

The Positive Effect of the Integrated Orthogeriatric Care Model on Quality Indicators Pre- and Post-operatively for Hip Fracture Patients 

The integrated orthogeriatric care model with shared responsibility and decision-making between the orthopaedic surgeon and the geriatrician has a positive effect on quality indicators pre-and post-operatively for hip fracture patients.


Orthogeriatric care improves the hip fracture patient’s opportunity to attain prefracture level of mobility, independency and health, but there is no consensus on which model of orthogeriatric care that is best to achieve patients prefracture function. The aim of this study was to evaluate two different orthogeriatric models for patients with hip fracture. The study was conducted at Oslo University hospital in Norway and included 516 patients >65 with a hip fracture.


An ‘Integrated Care Model’ (ICM) was compared with a ‘Geriatric Consult Service’ (GCS). The differences between the care protocols of these models were that in ICM there was an evening round by the geriatrician on call preoperatively and the ICM group followed the routine in the orthogeriatric unit, where every day the orthogeriatric team (geriatrician, orthopaedic surgeon, hip fracture nurse and physiotherapist) participated at interdisciplinary rounds to the patients. The patients in the GCS group followed the routine in the orthopaedic trauma ward with rounds by the orthopaedic surgeon and nurse. In addition, they were offered a visit by the geriatrician but without the orthogeriatric team.


The results of the study indicated that the ICM with co-management of the patients and shared decision-making and responsibility between the orthopaedic surgeon and the geriatrician, provided equally good or better results on all the quality indicators measured.  The quality indicators regarding postoperative care (removal of urinary catheter 1 postoperative day, mobilisation 1 postoperative day and treatment with antiosteoporotic drugs) has the highest level of improvement at the ICM model, in addition to preoperative nerve block. There was no statistically significant difference between the 2 models in terms of mortality.

Dr Lene Solberg, one of the authors, stated: ‘ICM provides better acute care for the hip fracture patients measured by selected quality indicators. However, more research which embraces a wider spectrum is needed to clearly state that a model of co-management between the orthopaedics and the geriatricians affects important outcome measures, such as mobility, post-discharge dependency and quality of life.’ 

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