Crotty M, Miller M, Whitehead C, Krishnan J, Hearn T
Flinders University, Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daw Park SA, Australia.
J Qual Clin Pract. 2000 Dec;20(4):167-70. doi: 10.1046/j.1440-1762.2000.00385.x.
Hip fractures are a growing problem and new models of care have been called for. However, patients from residential care are rarely considered in these discussions. Hip fracture is a common serious problem for older people in residential care with profound effects on subsequent mobility and quality-of-life. There are no Australian data documenting differences in hospital treatments offered to patients from the community and residential care to inform discussions. In a prospective audit we describe the treatment and 4 month outcomes of patients with fractured hips who were admitted to Flinders Medical Centre in South Australia from the community and residential care between August 1998 and June 1999. Information was collected on prefracture health, types of surgical and rehabilitation treatments and dependency. Of the 215 older adults who were admitted during this time, 183 agreed to participate (119 from community and 64 from residential care). Surgical management of the fracture was not affected by admission accommodation. Those from residential care had short hospital stays, less rehabilitation and access to physiotherapy. Although 61% of those from residential care were classified as independently mobile prefracture, by 4 months this had declined to 32% of survivors. Strategies to improve outcomes in those from residential care include: early identification of those walking independently prefracture with assessment by rehabilitation teams. Inclusion of liaison with community therapists in the clinical pathway and in selected cases use of 'rehabilitation at home' services to provide physiotherapy services should be considered.
髋部骨折问题日益严重，人们呼吁建立新的护理模式。然而，这些讨论中很少考虑到来自寄宿护理机构的患者。髋部骨折是寄宿护理机构中老年人常见的严重问题，对其后续行动能力和生活质量有深远影响。澳大利亚没有相关数据记录社区患者和寄宿护理机构患者在接受医院治疗方面的差异，以供讨论参考。在一项前瞻性审计中，我们描述了1998年8月至1999年6月期间从社区和寄宿护理机构入住南澳大利亚弗林德斯医疗中心的髋部骨折患者的治疗情况及4个月后的结果。收集了骨折前健康状况、手术和康复治疗类型以及依赖程度等信息。在此期间入院的215名老年人中，183人同意参与（119人来自社区，64人来自寄宿护理机构）。骨折的手术治疗不受入院住所的影响。来自寄宿护理机构的患者住院时间短，康复治疗较少，且难以获得物理治疗。尽管来自寄宿护理机构的患者中有61%在骨折前被归类为可独立活动，但到4个月时，这一比例在幸存者中降至32%。改善寄宿护理机构患者治疗结果的策略包括：康复团队对骨折前能独立行走的患者进行早期识别和评估。在临床路径中纳入与社区治疗师的联络，在某些情况下应考虑使用“居家康复”服务来提供物理治疗服务。
