Abstract
Purpose: Fractures of the proximal femur are increasing in incidence as the population ages. In order to address this problem the Province of Ontario, Canada (population 14 million) has advocated an integrated model of care.
Method: A policy to improve the outcome for patients sustaining hip fractures has been developed. It has been implemented in the 14 health regions of the province. The objectives are:
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All surgical procedures to be performed within 48 hours of patient’s admission to hospital.
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Surgical treatment of hip fractures must permit unrestricted weight bearing.
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A structured acute care post-operative course followed by admission to progressive rehabilitation.
Results: Since the implementation of this policy 90% of all hip fracture patients are receiving definitive surgical treatment within 48 hours of admission. Site variations are identified and remedial actions implemented for those hospitals which fail to meet this target. Acute care length of stay following hip fracture has declined from a mean of 17 days to a mean of 8 days. The number of patients with hip fractures returning to their pre-injury residence has increased significantly from approximately 35% to 70% at 3 months post-fracture.
Conclusion: A structured program for hip fracture care can be developed in large population areas and has been implemented for the approximate 10,000 patients sustaining hip fractures annually within our jurisdiction. This model should be broadly applicable to other health regions.
Correspondence should be addressed to: COA, 4150 Ste. Catherine St. West Suite 360, Westmount, QC H3Z 2Y5, Canada. Email: meetings@canorth.org
