Learning Objective #1: Improve clinical outcomes of femur neck fracture in Japan, acute care and treatment processes were compared among Japan, US, and UK

Learning Objective #2: Look at acute treatments for femur neck fracture in Japan and investigate the cost-effectiveness

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Objectives: To improve clinical outcomes of femur neck fracture in Japan, acute care and treatment processes were compared among Japan, US, and UK. Methods: Study 1: Clinical indicators such as length of hospital stay, medical expense, ADL at discharge, complication rate, and rate of returning home were selected as outcomes from national survey and other resources, and outcome-related process indicators were selected by researchers and then compared among three acute orthopedic hospitals in Japan, US, and UK. Literature was reviewed to ensure that data from hospitals was above the average for the nation. Interviewing medical staff, analyzing clinical pathways, and protocols were used to collect data. Expense was calculated by implementing the US and UK's treatment process in Japan with Japan's medical fees. Study 2: Thirteen expert orthopedic specialists in Japan were selected and asked to develop an ideal treatment process for femur neck fracture by the Delphi method based on the results of study 1. Ethical Consideration: Consent was taken by each hospital; however, patients' consent was waived by IRB because individual data was not used. Results: Study 1: Items for improving outcomes in Japan were preoperative traction and insertion of a urethral catheter and drain. Differences between the three treatment processes were observed in postoperative weight-bearing and rehabilitation process, discharge planning, complication preventions, and pain control methods. Study 2: Through Delphi method, the ideal treatment process was set; physical therapy, postoperative weight-bearing, ambulation and discharge were set earlier. It was expected that after the standardization /benchmarking progressed in Japan, the length of stay would be shortened, and medical expense would be cut by 24 billion-42.5 billion yen. Conclusion: This study suggests that standardization of treatment processes leads to improvement of patient outcomes, as well as to a reduction in medical expenses.