Key result
Post-discharge management via a Patient-Centered Medical Home program significantly reduced all-cause mortality at 6 months compared to standard care (11% vs. 26%, p<0.01) in hip fracture patients.
Why the study?
Does a Patient-Centered Medical Home post-discharge model reduce mortality in elderly patients following hip fracture surgery?
Cohort (n=194)
Yes
Does a Patient-Centered Medical Home post-discharge model reduce mortality in elderly patients following hip fracture surgery?
A Patient-Centered Medical Home post-discharge management model significantly reduced 6-month mortality in elderly patients following hip fracture surgery compared to standard care.
May support broader post-discharge models in hip fracture care; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Hip fracture patients experience high morbidity and mortality rates in the first post-operative year after discharge. We compared mortality, utilization, costs, pain and function between two prospective cohorts of hip fracture patients, both managed with identical perioperative protocols and one group subsequently managed via a "Patient-Centered Medical Home" (PCMH) primary care management model. METHODS: We analyzed 6 and 12-month outcomes from two matched cohorts of patients who were surgically treated for hip fracture from January 1, 2010 to June 30, 2011 at two hospitals (n = 194). Controls did not receive PCMH and were matched to cases on surgery date, sex, age, and comorbidities. Mortality and healthcare utilization were the primary outcomes studied, with medical costs, quality of life, pain and function at 12 months assessed as secondary outcomes in a subgroup. Survival analysis, regression and Student-t testing were used with p < 0.05 considered significant. RESULTS: At 6 months, PCMH patients had significantly lower mortality than patients receiving standard care (11% vs. 26%, p < 0.01). At 12 months, a difference persisted (23% vs. 30%, p = 0.12) but was no longer statistically significant. Mean quality of life scores were similar (0.73 vs. 0.76, p = 0.49) and Harris Hip score was slightly improved for PCMH (73 vs. 64, p = 0.04). Mean costs per patient per month were lower for PCMH but not significantly different ($69 vs. $141, p = 0.20 for pharmacy costs; $1212 vs. $1452, p = 0.45 for non-pharmacy costs). CONCLUSIONS: Patients receiving aggressive post-discharge care from a PCMH program showed significant benefits in terms of reduced mortality at 6 months, with similar costs and functional outcomes at 12 months. PCMH was not shown to improve all outcomes studied, but these results suggest that ongoing Medical Home management can have some benefit for patients without negatively impacting function or cost.
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Graham et al. (2014) conducted a cohort in Hip fracture (n=194). Patient-Centered Medical Home (PCMH) post-discharge management vs. Standard care was evaluated on All-cause mortality at 6 months (p=<0.01). Post-discharge management via a Patient-Centered Medical Home program significantly reduced all-cause mortality at 6 months compared to standard care (11% vs. 26%, p<0.01) in hip fracture patients.
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