Background: The elderly population is growing rapidly and those aged 65 and older comprise nearly 40 percent of hospitalized adults. As the population continues to age, this number is expected to rise. Promoting age-friendly care has been at the forefront of many health systems’ goals.
Purpose: Our Hospital Medicine Group’s Orthopedic Hospitalist co-management program set out to identify and treat fragility fractures in older adults through an interdisciplinary standardized approach integrating a set of four evidence-based elements of high quality care, known as the “4Ms” which primarily focus on the needs of the aging community in a clinical setting.
Description: We designated a core group of highly specialized orthopedic hospitalists (OHOS) to work closely with the orthopedic surgeons to coordinate and improve the perioperative care of patients admitted to the orthopedic service. Collaborating with orthopedic surgeons through our orthopedic co-management model has proven to ensure the highest quality care while fulfilling the needs of older hospitalized patients. In March of 2018, one initiative within the co-management initiative that was launched was AGS CoCare: Ortho: a Geriatric-Orthopedics Co-Management model (GOCo) built on principles and practices of geriatric medicine. The American Geriatric Society (AGS) which is supported by the John A. Hartford Foundation in collaboration with the University of Rochester & Brown University chose Northwell Health as the alpha site with our Hospital being the first implementation site for AGS CoCare: Ortho. AGS CoCare can be thought of as a care model in sorts for the elderly aged 65 and older that are being admitted to the hospital in an acute setting with hip fractures requiring orthopedic surgery. This model consists of patient co-management between orthopedics and medicine, dissemination of best practice, data management, and team support with a goal of improving the care we provide to this complex patient population. Integrating the 4Ms – What Matters, Medication, Mentation, and Mobility – model into routine care for hip fracture patients is a key driver of age-friendly care. Encouraging early mobility post-op in addition to screening all hip fracture patients for dementia and delirium while conducting a thorough review of their medications and aligning the care plan with what matters most to the patient and their families has provided some positive results. Pain scores are down from 62% to 55% post-op, length of stay is down from 7.1 to 6.8 days, hospital mortality is down from 3.6% to 2.2% and morphine use is down from 3.6% to 2.2%.
Conclusions: As the population is aging, the so-called “silver tsunami” is growing inside our hospitals. Hospitalists’ involvement, particularly as seen in perioperative care, helps fulfill the needs of this aging population. Integrating the 4Ms can lead to improved patient outcomes, hospital throughput metrics and help contribute to the success of developing age-friendly hospitals and health systems.