1 Introduction

Over the past several years, a great deal of literature has been published about the benefits of starting and using an enhanced care model for fragility fracture patients (FFPs). Many care models have been described in the literature [1, 2], four of which are presented in chapter 2.1 Models of orthogeriatric care. The benefits of such models include improved quality of patient care, shorter length of hospital stay (LOS), fewer adverse events during and after the hospital stay, improved collegiality among healthcare providers, and reduced costs of care [3–7].

Despite these reported benefits, most hospitals have not yet adopted a comanaged care model. Many possible reasons exist for not implementing such a program. This chapter covers some of these barriers to the implementation of an organized geriatric fracture program.

2 If an organized program is better, why doesn′t everyone want one?

In some centers, physicians and institutional team members may be of the opinion that their usual care model is acceptable and performing adequately. Although there has been a universal emphasis on the reduction of LOS, few hospitals have made the direct association between a standardized geriatric fracture care program, reduced LOS, and improved quality of care. Additionally, there are a number of surgeons and physicians who believe no one else needs to tell them how to take better care of their FFPs. Some perceive the model as too hard to implement [8]. Other centers suffer from a lack of physician leadership, resulting in failure to implement such a model of care [8]. In some centers, there are major institutional barriers to implementing a program [8]. Additionally, many other issues have been described that interfere with the implementation of an organized, standardized, and comanaged geriatric fracture program ( Table 2.2-1 ). In such cases, the patients suffer from a lack of organized care and experience more adverse events and longer LOSs as a result.