奥克兰髋部骨折：两所大医院的两种不同护理模式。

Hip fracture in Auckland: contrasting models of care in two major hospitals.

机构信息

AT & R Department, Counties Manukau District Health Board, New Zealand.

出版信息

Intern Med J. 2009 Feb;39(2):89-94. doi: 10.1111/j.1445-5994.2008.01721.x.

DOI:10.1111/j.1445-5994.2008.01721.x

PMID:18771434

Abstract

BACKGROUND

The optimal setting and design of care for elderly patients with hip fracture is unknown. North Shore Hospital (NSH) and Middlemore Hospital (MMH) are two major hospitals in the Auckland region operating different models of orthogeriatric care. The aim of the study was to compare hip fracture care between NSH and MMH.

METHODS

A retrospective case record audit of patients aged 65 years and older with hip fracture from July to December 2004 at MMH and NSH was carried out.

RESULTS

Charts for 203 patients (101 MMH and 102 NSH) were reviewed. The two groups were similar in age (mean age 83.2 years), sex (80% women) and other casemix factors. Median time from admission to theatre was shorter in NSH (21 vs 44 h, P < 0.0001). Length of stay was significantly shorter at NSH (mean difference 4.4 days, 95% confidence interval 1.1-7.6 when adjusted for casemix factors). Significantly more NSH patients were transferred for rehabilitation than MMH patients (75 vs 51%). At discharge, significantly more MMH patients (34 vs 14%) were treated with alendronate. Of 126 patients admitted from home, 81% returned home, 4% went to rest homes, 13% to private hospitals and 2% died; differences between centres were not significant. Overall inpatient mortality was 3.9%.

CONCLUSION

The orthogeriatric model of care at NSH was associated with a shorter overall length of stay, earlier transfer to the Assessment, Treatment and Rehabilitation setting, and a higher proportion rehabilitated in Assessment, Treatment and Rehabilitation. Outcomes in terms of discharge destination and 6-month mortality were similar at both centres.

摘要

背景

老年髋部骨折患者的最佳治疗环境和方案仍不明确。北岸医院（NSH）和Middlemore 医院（MMH）是奥克兰地区的两家主要医院，它们提供不同模式的骨科老年病学治疗。本研究旨在比较 NSH 和 MMH 之间的髋部骨折治疗效果。

方法

对 2004 年 7 月至 12 月期间，在 MMH 和 NSH 接受治疗的年龄在 65 岁及以上的髋部骨折患者进行回顾性病历记录审计。

结果

共分析了 203 例患者（MMH 组 101 例，NSH 组 102 例）。两组患者的年龄（平均年龄 83.2 岁）、性别（80%为女性）和其他病例组合因素相似。NSH 组患者从入院到手术室的时间中位数更短（21 小时 vs 44 小时，P < 0.0001）。NSH 组的住院时间明显更短（平均差异 4.4 天，调整病例组合因素后，95%置信区间为 1.1-7.6）。与 MMH 组相比，更多的 NSH 患者被转往康复科（75 例 vs 51 例）。出院时，更多的 MMH 患者（34 例 vs 14 例）接受了阿伦膦酸钠治疗。在从家中入院的 126 例患者中，81%返回了家中，4%入住了疗养院，13%转往了私立医院，2%死亡；两个中心之间的差异没有统计学意义。总体住院死亡率为 3.9%。