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John R. Stephens, MD

Hip fracture is a common and morbid condition, affecting a patient population with significant medical co-morbidities. Different medical co-management models have been studied, with conflicting reports of the effect on patient outcomes. A newly-published study led by Dr. John R. Stephens, professor of medicine and pediatrics in the division of hospital medicine, compared outcomes for patients with hip fracture managed by hospitalist versus non-hospitalist services. Findings suggest there is a benefit to hospitalist co-management.

Hospitalists conducted a retrospective cohort study of patients with hip fracture over 1 year, comparing those on hospitalist versus non-hospitalist services, which included 124 hospitalist and 53 non-hospitalist patients. Outcomes included 30-day readmission and hospitalization ≤7 days, with comparison between patients admitted to hospitalist versus non-hospitalist services. A multivariate analysis was performed, adjusting for age, gender, race/ethnicity, insurance type, ASA score, and blood transfusion during hospitalization and days from admission to surgery.

The study showed patients with hip fractures at UNC Medical Center were less likely to be readmitted after discharge from hospitalist versus non-hospitalist services. Stephens recognized possible reasons for this finding.

“One possibility is that the use of ‘standard work’ for care of specific populations, such as our use of protocols via order sets, generates better outcomes,” Stephens said. “Another possibility is that specialized practitioners of hospital medicine may be more able to effectively manage hospitalized patients in the setting of co-management with a surgical service.”

In unadjusted analysis, hospitalist patients were more likely to have hospitalization ≤7 days. In adjusted analysis, hospitalist patients had lower odds of 30-day readmissions, but no difference in odds of hospitalization ≤7 days.

“While our study was modestly-sized and employed an uncontrolled design, it adds to the body of literature suggesting there is a benefit to medical (and particularly hospitalist) co-management of patients with hip fracture,” said Stephens. Hopefully, further research will confirm these findings and further advance care for this vulnerable patient population.”

Study participants included Jamison W. Chang, MD, E. Allen Liles, MD, Mukhtar Adem, MD, and Carlton Moore, MD.

Published in the Journal of Hospital Practice, the “Impact of hospitalist vs. non-hospitalist services on length of stay and 30-day readmission rate in hip fracture patients” can be found here.