The test of an empirically-derived model to time, sequence, and coordinations of healthcare given to persons over the age of 65 who fracture a hip is the focus of the proposal. The proposed test is justified by: the unchanging mortality rates over the past 20 years among elderly who experience hip fractures; the relatively new deliberate emphasis on Total Quality Management which requires careful explication of the processes of care; the lack of research testing of the efficacy of care management protocols across settings; and healthcare delivery system inefficiencies thought to result in increased cost and decreased quality of care. The conceptual framework of the project (Outcomes-Focused Care Management [OuTCM] Model for Care of Elderly with Hip Fractures) provides the study framework; it is based on a generic structure/process/outcome model for health services research and prior research findings establishing the trajectory of recovery from hip fracture. The interventions include use of a scientifically-derived extended care management protocol for improving recovery outcomes in elderly clients experiencing hip fracture across care settings (the ECP), and the use of the ECP by a Gerontological Advanced Practice Nurse (GAPN) who will serve as a case manager for one study group. The ECP specifies client outcomes that occur as a result of the intervention in four phases of post-fracture recovery: acute, subacute, mobility, and wellness. The GAPN will use the ECP to guide and coordinate care by multiple caregivers across care settings over six months. The study will be carried out within the HealthEast and Wilder systems of integrated service delivery; they include acute care facilities, a rehabilitation facility, a transitional care facility, nursing homes and home care agencies. A randomized two-group design is proposed. One hundred forty clients meeting the sampling criteria (admission to one of three HealthEast acute care facilities for repair of a hip fracture occurring at home, Medicare eligible, age > 65, ambulatory prior to fracture) will be randomly and equally assigned to one of two groups: an experimental group which will receive care according to the ECP which is managed and coordinated by the GAPN, and a control group which will only receive care according to the ECP. Analysis of intervention effects using repeated measures ANOVA and t-tests will include: 1) between-group comparisons of study subjects on achievement of specified recovery outcomes (health status, functional independence, living at home, and satisfaction) at the end of each phase and at 12 months post fracture (hypothesis 1 and research question 1); and 2) comparisons between caregivers on the extent to which they implemented the ECP to effect outcomes (hypothesis 2 and research question 2).
| Krichbaum, Kathleen (2007) GAPN postacute care coordination improves hip fracture outcomes. West J Nurs Res 29:523-44 |
