Friedman Susan M, Mendelson Daniel A, Kates Stephen L, McCann Robert M
Department of Medicine, Division of Geriatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA.
J Am Geriatr Soc. 2008 Jul;56(7):1349-56. doi: 10.1111/j.1532-5415.2008.01770.x. Epub 2008 May 22.
Hip fractures in older adults are a common event, leading to substantial morbidity and mortality. Hip fractures have been previously described as a "geriatric, rather than orthopedic disease." Patients with this condition have a high prevalence of comorbidity and a high risk of complications from surgery, and for this reason, geriatricians may be well suited to improve outcomes of care. Co-management of hip fracture patients by orthopedic surgeons and geriatricians has led to better outcomes in other countries but has rarely been described in the United States. This article describes a co-managed Geriatric Fracture Center program that has resulted in lower-than-predicted length of stay and readmission rates, with short time to surgery, low complication rates, and low mortality. This program is based on the principles of early evaluation of patients, ongoing co-management, protocol-driven geriatric-focused care, and early discharge planning. This is a potentially replicable model of care that uses the expertise of geriatricians to optimize the management of a common and serious condition.
老年人髋部骨折是常见事件，会导致严重的发病率和死亡率。髋部骨折先前被描述为一种“老年疾病，而非骨科疾病”。患有这种疾病的患者合并症患病率高，手术并发症风险高，因此，老年病医生可能非常适合改善护理结果。在其他国家，骨科医生和老年病医生对髋部骨折患者的共同管理已取得了更好的结果，但在美国很少有相关描述。本文介绍了一个共同管理的老年骨折中心项目，该项目已实现低于预期的住院时间和再入院率，手术时间短，并发症发生率低，死亡率低。该项目基于对患者进行早期评估、持续共同管理、以方案为导向的以老年患者为重点的护理以及早期出院计划等原则。这是一个潜在可复制的护理模式，利用老年病医生的专业知识优化对一种常见且严重疾病的管理。
