Association of Hospitalist Co-management and Patient Outcomes with Patients Hospitalized for Hip Fracture.

Abstract

Patients admitted for hip fracture surgery may receive care from a team led either by the operating surgeon or a hospitalist. To describe the prevalence of the hospitalist care model for hip fracture admissions and its association with patient outcomes. We conducted a retrospective cohort study of patients admitted in 2018-2019 for fracture of the head and neck of the femur (ICD10 S72.0x-2x). We compared outcomes at hospitals with low versus high use of the hospitalist care model. Our exposure was the hospital-level adoption of hospitalist care, categorized into quartiles. Fee-for-service Medicare patients 66 years old or greater. Length of stay (LOS), professional services (Part B) inpatient spending, specialty consultation, discharge to home, all-cause 7- and 30-day readmissions, and 30-day mortality. A total of 294,150 patients with hip fracture were admitted to 2466 hospitals. Patients cared for in low-use (Q1) versus high-use (Q4) hospitals did not differ meaningfully in demographic characteristics or comorbidities. Hospitals ranged in use of the hospitalist care model from 12% in low-use (Q1) hospitals to 81% in high-use (Q4) hospitals. Low-use hospitals had significantly higher inpatient consult use (unadjusted: Q1 vs Q4, 1.06 vs 0.63 consults, p < 0.0001; adjusted: -0.36, p < 0.001) and length of stay (unadjusted: Q1 vs Q4, 6.04 vs 5.94 days, p < 0.0001; adjusted: -0.09 days, p < 0.05), but no significant difference in adjusted analyses for spending, likelihood of discharge home, 7- and 30-day readmission, or 30-day mortality. Hospitalist care for older adults admitted for hip fracture surgery is both common and associated with slightly shorter length of stay.