The Case for Comanagement and Care Pathways for Osteoporotic Patients with a Hip Fracture

Rapid preoperative evaluation and clearance is an essential component of hip fracture care. Evidence-based guidelines should be used to reduce unnecessary testing and minimize delays. Current practice guidelines recommend surgery within 24 to 48 hours of presentation, and a well-designed pathway can typically facilitate rapid surgery for all but the most medically unstable patients. Institutionalized initiation of osteoporosis management in patients with a hip fracture improves patient outcomes and is cost-effective but must overcome multiple barriers. Several pragmatic programs have been developed to help orthopaedic surgeons facilitate this process. Comanagement services need substantial work to establish, require teamwork among multiple engaged teams, and should create a culture of continuous process improvement._When implemented successfully, comanagement services with dedicated care pathways can improve outcomes, reduce complications, streamline care, and result in cost savings. © 2018 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED.