Clinical and health-economic impact of orthogeriatric care models in Belgium: A population-based data registry study.

Abstract

This study evaluated six orthogeriatric care models for older fracture patients in Belgium. Integrated care on surgical wards reduced emergency department visits, while consultation on request on geriatric wards yielded the highest survival. All models had comparable costs except for integrated care on a geriatric ward, which was more expensive. This study assessed the (cost-)effectiveness of systematic collaboration (systematic consultation or integrated care) between surgical and geriatric teams compared to consultation on request in Belgium. This registry-based study included patients aged ≥ 75 years admitted with hip, pelvis, wrist, shoulder, or vertebral fractures in 2019. We compared six care models: consultation on request, systematic consultation, or integrated care, on either surgical or geriatric wards. The primary outcome was 1-year mortality. Secondary outcomes included 30- and 90-day mortality, 1-year survival time, length of stay (LOS), 30- and 90-day emergency department (ED) visits and unplanned readmissions, and 1-year institutionalization. Cost-effectiveness was assessed using survival time and total direct costs within one year. We analyzed 8,302 patients across 60 hospitals. LOS was shortest for consultation on request on surgical (10 days) and geriatric wards (12 days), and for integrated care on a surgical ward (11 days). ED visits at 30 (5.9%) and 90 days (11.0%) were lowest for integrated care on a surgical ward. Survival time was highest for consultation on request on a geriatric ward. Mortality, institutionalization, and unplanned readmissions were similar across models. Costs were mostly comparable (€16,445-€17,829) except for integrated care on a geriatric ward, which was more expensive (€18,726). Integrated care on a surgical ward reduced ED visits without compromising outcomes. While consultation on request on a geriatric ward showed the highest survival time at similar cost, absolute differences were minimal, thereby emphasizing the overall health-economic comparability across models.