Development of a Value-based Algorithm for Inpatient Triage of Elderly Hip Fracture Patients. Issue 13 (1st July 2020)

• Record Type: Journal Article
• Authors: Konda, Sanjit R.; Lott, Ariana; Egol, Kenneth A.
• Is Part Of: Journal of the American Academy of Orthopaedic Surgeons. Volume 28:Issue 13(2020)
• Publication Date: 2020-07-01
• Subjects: Orthopedics -- Periodicals; Orthopedic surgery -- Periodicals; Joint Diseases -- Periodicals; Orthopedics -- Periodicals; Orthopedic surgery; Orthopedics; Periodicals; 616.7005
• DOI: 10.5435/JAAOS-D-18-00400
• Languages: English
• ISSNs: 1067-151X

Abstract

Abstract : Introduction: The purpose of this study was to combine a validated middle-age and geriatric trauma risk assessment tool (STTGMA) with a novel cost-prediction tool to create an objective triage tool for elderly hip fractures that would guide value-based care initiatives. Methods: From October 2014 to January 2018, all patients aged ≥55 years who were admitted with a primary diagnosis of hip fracture to a single level 1 trauma center were enrolled. Upon evaluation in the emergency department, demographics, injury severity, and functional status were recorded to calculate the trauma triage score (STTGMARisk ). A model to predict high-cost hip fracture patients was created using similar variables (STTGMACost ). Results: Three hundred sixty-one consecutive operative hip fracture patients were enrolled. Inpatient mortalities were skewed toward STTGMARisk 3 with 21.4% of patients in this high-risk group ultimately expiring during their hospitalization. High-cost patients were correctly skewed to the STTGMACost 2 and STTGMACost 3 groups with 88.9% of all high-cost operatively treated hip fracture correctly triaged to these cohorts. Statistically significant variations were found in cost within each STTGMARisk group. Conclusions: A simple risk score calculated upon admission (STTGMARisk and STTGMACost ) was able to be used as a triage tool not only to differentiate increased mortality risk but also to predict high-cost patients based on resource utilization in hip fracture patients. Level of Evidence: Prognostic, level II