We know how to reduce mortality after hip fracture. But do we care enough to?

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  1. Boris Sobolev

    Thank you for citing the BC Hip Fracture Redesign Project!
    Prognostic and prescriptive analytics transform hip fracture care in BC, Canada and globally. At its core are personalized treatment pathways. Ultimately, we *envision* a health care system in which predictive analytics routinely recommends treatments and predicts outcomes using clinical histories of patients and their past encounters with the health system.
    Using advances of Data Science, we develop, implement and evaluate algorithms that predict likely treatment outcomes, health services use, the odds of failure to regain mobility and independence, the odds of readmission, and the odds of death, after sustaining hip fracture.
    In addition to predicting high-risk and high-use patients, we develop, implement and evaluate algorithms that rank treatment pathways through hospital and rehabilitation phases of hip fracture care. For each patient, our recommendation models suggest personalized care pathways that most likely lead to improved survival, mobility and independence.
    Our recommendation algorithms answer the question that policymakers, hospital administrators and caregivers tell us matters most in hip fracture care – how to identify patients at risk of hospital readmission or failure to regain mobility, so that the health system can intervene to prevent this transition earlier?

  2. Lesley Barron

    So I really dislike the idea that yet another “Centre of Excellence” for yet another specific condition is going to save money and be better for patients. We need more generalist care and this is a perfect example of creating yet another silo with the accompanying demand for extra resources to do so. These frail elderly patients need to be treated in their communities, close to their spouses and remaining support systems of friends and family. Transferring these patients is often a logistical nightmare for hospitals like mine and can only delay care. Want to have hip fractures repaired in under 6 hours? Adding in a transfer is one sure way to make sure no hip fractures get fixed in that time frame. The idea that orthopedic surgeons in small hospitals are managing these cases on their own is ridiculous and shows a lack of understanding of how small community hospitals work. Hospitalists, internists and family doctors with admitting privileges (an unfortunately small number but these are the people who already know these often complex patients well) are often the ones managing these patients medical issues from admission to discharge. Hip fractures are common- we need more funding to strengthen access to appropriate generalist care where our patients live, not pour more resources into ever more siloed subspecialized care in larger centres.

  3. Robert James

    As a retired GP, let me make a few comments.
    First, I agree with the previous comment that these patients need to be treated as close as possible to their homes. Involvement of family and their ongoing GP (who will be managing their care once they return to the community) is facilitated by local care, not (more) specialized care. Having a centre of excellence would only move these patients further from where they come.
    Second, the more the number of people involved in their care, the more likely there will be a scary and perhaps fatal communications error between them; and the more likely time will be spent on meetings for the care-givers rather than in direct, needed, patient care. GP’s have been doing wholistic care for generations, and could still, if they were not being actively discouraged from in-hospital care.
    In summary, I think the money could be better spent on patient advocates, more and better nursing, and supports for the family doc who want to work with his/her patients in the hospital.

  4. Cameron Jerome

    Thank you for your article. I think the data supporting cost-savings and improved outcomes demand that we take a close look at implementing shared-care centres for hip fractures.
    It is important to keep patients close to their home communities. But if 10 percent of these patients are dying within 30 days and more than 30 percent dying within 1 year, prioritizing their location is of diminishing relevance. Most patients undergoing surgery value good outcomes over anything else.
    A shift in our approach to hip fracture care is necessary, and we must do our best to make decisions based on the best available evidence. You have done a great job promoting this idea in your article.

  5. Cara Elliott

    Very well-written and inciteful. Thank you for sharing your opinion and perspectives.

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