Impact of family physician–led hospitalist intervention methods in the multidisciplinary management of hip fracture: A retrospective cohort study

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HIP FRACTURES are associated with high mortality and morbidity, 1,2 the rates of which can be lowered by comprehensive hospital care.1,2 Geriatricians can play a major role in the comprehensive care of patients with hip fractures, although specialised geriatricians are limited in number.Hospitalists might therefore assume a useful role in interdisciplinary care; they can respond to consultations for preoperative medical evaluation and the management of postoperative complications, or they can be responsible for the entirety of patient care with an admission of the patient to the Department of General Internal Medicine.In hospitalist consultant models, a hospitalist works with an orthopaedist during perioperative medical evaluation and management.As the name implies, hospitalists serve as consultants with consideration of the overall care of hospitalised patients.The hospitalist consultant model has been shown to decrease time to surgery and length of stay compared with conventional orthopaedic treatment.3,4 Meanwhile, in the hospitalist model, the hospitalist team leads the management of perioperative and postacute care.Hospitalist models have also been shown to decrease time to surgery and length of stay compared with conventional orthopaedic treatment, as well as reducing time from surgery to dismissal and postoperative complications.[5][6][7][8] In Japan, some studies have evaluated the effect of the co-management model.A retrospective cohort study of a multidisciplinary model with internists and a geriatrician showed a shorter time to surgery and hospital stay than the national average.9 Another retrospective cohort study of a hospitalist co-management model showed shorter times to surgery than conventional orthopaedic surgeon-led care.10 The clinical effects of the different hospitalist intervention methods have not yet been sufficiently investigated.Therefore, this study examined the effect of these two hospitalist intervention methods (hospitalist model and hospitalist consultant model) on morbidity in patients with hip fractures compared with conventional orthopaedic surgeon-led care. Methods Study designWe conducted a retrospective cohort study at Akashi Medical Centre (Hyogo, Japan), a community medical support centre in Japan that includes an emergency medical care centre and primary care practice.Patients who

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