ID-5184 Wonca Abstracts supplement A-K 13-10-23 - Flipbook - Page 301
WONCA 2023 Supplement 1: WONCA 2023 abstracts (A–K)
A
B
C
D
E
F
G
H
I
J
K
Impact of family physician-led hospitalist intervention
methods in the multidisciplinary management of hip
fracture: A retrospective cohort study
Dr Naoto Ishimaru1, Takahiro Waki1, Toshio Shimokawa2, Shimpei Mizuki1, Jun Ohnishi1,
Yohei Kanzawa1, Takahiro Nakajima1, Tomonori Yano1, Kenjiro Ito1, Shinji Matsushima1, Saori Kinami1
1
Akashi Medical Center, 2Clinical Study Support Center, Wakayama Medical University
Objectives
Hip fracture is associated with high morbidity and mortality, the rates of which can be improved
by comprehensive hospital care. In a hospitalist consultant model, orthopaedic surgeons play an active
role in collaboration with hospitalists in preoperative medical evaluation and management. Meanwhile,
in a hospitalist model, hospitalists have a comparatively more active role in patients’
care. We examined the impact of these hospitalist intervention methods on morbidity in patients
with hip fractures.
Methods
We conducted a retrospective cohort study of our patients who underwent surgery for hip fracture
between April 2017 and March 2022. Hip fractures were managed conventionally in the orthopaedic
department, and we then launched a hospitalist consultant model in April 2019 and a family physicianled hospitalist model in April 2020. The primary outcome was the perioperative complication rate,
comparing patients in each model. Secondary outcomes included the time to surgery, the length of
stay and in-hospital mortality. Multivariate analysis was adjusted for age, gender and any significant
variables shown in univariate analysis.
Results
Among 982 patients, 329, 224 and 429 patients were treated by the orthopaedic department, within
the hospitalist consultant model and within the hospitalist model, respectively. In adjusted analysis,
time to surgery was shorter if managed within the hospitalist model (OR –0.259; 95% CI: –0.502,
–0.016), but there was no difference in length of stay, in complications or in-hospital mortality.
Conclusions
A family physician-led hospitalist model might facilitate earlier surgery for hip fractures than by a
conventional care model. Morbidity was not affected in our study, perhaps due to improved detection
of complications.
299