Academic journal article Journal of Healthcare Management

Using a Comanagement Model to Develop a Hip Fracture Integrated Care Pathway

Academic journal article Journal of Healthcare Management

Using a Comanagement Model to Develop a Hip Fracture Integrated Care Pathway

Article excerpt

Gonzalo Barinaga, MD, Department of Surgery, Division of Orthopaedics and Sports Medicine, Southern Illinois University, Springfield; Zain Sayeed, MD, Department of Surgery, Chicago Medical School, North Chicago, Illinois; Afshin Anoushiravani, MD, NYU Langone Medical Center, Hospital for Joint Diseases, New York; Steven Scaife, Department of Surgery, Division of Orthopaedics and Sports Medicine, Southern Illinois University; and Mouhanad El-Othmani, MD, and Khaled Jamal Saleh, MD, FRCS, FACS, CPE, Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Michigan

EXECUTIVE SUMMARY

Hip fracture care represents a service line that profoundly affects patients' quality of life. As hospitals and physicians are motivated to improve quality, reduce costs, and maximize efficiency of care, several alignment models have been proposed under new healthcare legislation. Evaluation of such models as they pertain to hip fracture care warrants further investigation. In this article, we identify the current model of operations present in large healthcare organizations, examine the reasoning behind hospital-physician alignment, and describe specific comanagement principles that are common in healthcare settings. Furthermore, the effects of a comanagement model on a hip fracture integrated care pathway will be demonstrated through a case study. A comanagement team was formed at a Level I academic trauma center to create an integrated care pathway for the hip fracture service line. An internal data review of hip fracture cases before and after implementation of the pathway was undertaken to assess the impact of this model in terms of postoperative outcomes and resource utilization. The postimplementation group displayed more observant care while consuming fewer resources. Thus, the comanagement model described in this article serves as a powerful tool, allowing hospitals and physicians to improve the quality of care. This study provides recommendations based on our success in the hip fracture setting that may be extrapolated to improve service lines and healthcare efficiency nationally.

INTRODUCTION

The healthcare spending growth rate is projected to average 5.8% from 2014 to 2024 (Keehan et al., 2015). This rate will lead to $5.4 trillion in expenditures by 2024, consuming 19.6% of the national gross domestic product (Keehan et al., 2015). Such estimates are tied to rapid expansion of health insurance coverage under the Affordable Care Act, faster economic growth, and an aging population (Keehan et al., 2015). A sizable contributor to this expenditure is hip fracture care.

More than 250,000 hip fractures are estimated to occur annually in the united States, with the incidence continuing to increase in the elderly population (Brauer, Coca-Perraillon, Cutler, & Rosen, 2009; Nikkel et al., 2012). Patients who sustain a hip fracture typically present with comorbid illnesses and experience a major negative effect on their health-related quality of life (Burge et al., 2007; Nikkel et al., 2012). The combination of these variables intuitively increases the likelihood of greater costs of care. Studies have demonstrated that approximately 30% of patients with a hip fracture will die in the subsequent year, and many more will experience significant functional loss (Boonen et al., 2004; Randell et al., 2000; Vestergaard, Rejnmark, & Mosekilde, 2007). The costs associated with hip fracture repair are estimated to be $40,000 within the first year after the fracture and almost $5,000 annually in subsequent years (Brauer et al., 2009; Burge et al., 2007). To improve the quality of care and enhance efficiency, careful examination of current trends in hospital-physician relationships is necessary.

Various alignment strategies have become common practice in healthcare institutions and serve to drive cooperation between physicians and hospitals. We will discuss the current model of operations present in large healthcare organizations, examine motives behind hospital-physician alignment, and describe the comanagement model of alignment. …

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