Clinical effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: population-based longitudinal study.

ABSTRACT

OBJECTIVES: to evaluate orthogeriatric and nurse-led fracture liaison service (FLS) models of post-hip fracture care in terms of impact on mortality (30 days and 1 year) and second hip fracture (2 years). SETTING: Hospital Episode Statistics database linked to Office for National Statistics mortality records for 11 acute hospitals in a region of England. POPULATION patients aged over 60 years admitted for a primary hip fracture from 2003 to 2013. METHODS: each hospital was analysed separately and acted as its own control in a before-after time-series design in which the appointment of an orthogeriatrician or set-up/expansion of an FLS was evaluated. Multivariable Cox regression (mortality) and competing risk survival models (second hip fracture) were used. Fixed effects meta-analysis was used to pool estimates of impact for interventions of the same type. RESULTS: of 33,152 primary hip fracture patients, 1,288 sustained a second hip fracture within 2 years (age and sex standardised proportion of 4.2%). 3,033 primary hip fracture patients died within 30 days and 9,662 died within 1 year (age and sex standardised proportion of 9.5% and 29.8%, respectively). The estimated impact of introducing an orthogeriatrician on 30-day and 1-year mortality was hazard ratio (HR) = 0.73 (95% CI 0.65-0.82) and HR = 0.81 (CI 0.75-0.87), respectively. Following an FLS, these associations were as follows HR = 0.80 (95% CI 0.71-0.91) and HR = 0.84 (0.77-0.93). There was no significant impact on time to second hip fracture. CONCLUSIONS: the introduction and/or expansion of orthogeriatric and FLS models of post-hip fracture care has a beneficial effect on subsequent mortality. No evidence for a reduction in second hip fracture rate was found.