Hip fracture reduction in northwest arkansas nursing homes.

INTRODUCTION AND RATIONALE: Hip fracture rates in US nursing homes are alarmingly high, and low treatment rates of osteoporosis suggest a large degree of therapeutic nihilism among health care providers. Reports of reduction in hip fracture rates in the nursing home have been scarce, and experts wonder whether evidence-based treatments, effective in younger populations, will transfer to nursing home residents.

METHODS

A practice redesign project was undertaken in response to high rates of hip fracture in northwest Arkansas nursing homes. Hip fracture rates during the 3 years prior to the project were noted to be at benchmark, but were considered excessive. Those who fractured hips were typically not being treated for osteoporosis. The project sought a systematic method for addressing chronic illness, and the rigorous application of evidence-based medicine recommendations with a focus on hip fracture and preventable hospitalizations. There was a commitment to avoid soft reasons to undertreat the elderly, particularly ageism and the fear of polypharmacy.

OUTCOME MEASURES: Only 2 outcome measures were tracked before and during the project: hip fracture rates and rates of treatment of osteoporosis. Compliance with an adequate antiresorptive regimen was greatly improved, and a sustained reduction in rates of hip fracture was observed throughout the project. An 8-point post fall assessment was developed as an integral process for sustaining vigilance in patients at highest risk.

DISCUSSION: Problems with data collection were encountered and are likely to be typical for quality projects performed with no intention to publish. Because multiple interventions were offered to nursing home residents on an individualized basis, it is not possible to know which of these interventions factored into the outcomes. These interventions were constantly refreshed for patients at highest risk, and the large relative reduction in hip fracture rates suggests a synergistic effect.

CONCLUSIONS

These observations suggest that hip fracture rates in nursing home residents can be reduced using a rigorous individualized approach. A similar approach would be reasonable for consideration by other nursing home practitioners.