Departments of Orthopedic Surgery and Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Int J Endocrinol. 2010;2010:590751. doi: 10.1155/2010/590751.
We designed, implemented, and revised the Brigham Fracture Intervention Team (B-FIT) initiatives to improve in-hospital care of fracture (Fx) patients. Effectiveness was evaluated for 181 medical records of 4 cohorts in four successive years of consecutive patients who were admitted with a fragility hip Fx. The Discharge Initiative (DI) (computer-based) includes 1200 mg calcium and 1000 IU vitamin D(3) daily. The Admission Initiative (AI) was introduced one year later with reminders for serum 25OHD measurement, initiation of daily calcium (1200 mg) and vitamin D (800 IU), and an order for Endocrinology consultation, with an amendment for a computer-assisted reminder and a dose of D(2) (50 000 IU). Initially, the computer-based DI was more effective (67%) than the surgeon-driven AI (33%, P < .001). After introduction of a computer-assisted reminder, AI effectiveness increased to 68%. The marked prevalence of vitamin D insufficiency reaffirms the importance of incorporating vitamin D recommendations in Fx care pathways.
我们设计、实施和修订了布里格姆骨折干预团队（B-FIT）的举措，以改善骨折（Fx）患者的住院治疗。我们评估了连续四年的 4 个队列的 181 份病历，这些患者因髋部脆性骨折入院。出院干预（DI）（基于计算机）包括每天 1200 毫克钙和 1000 国际单位维生素 D（3）。入院干预（AI）在一年后引入，包括提醒测量血清 25OHD、开始每天补充钙（1200 毫克）和维生素 D（800 国际单位），并开内分泌科会诊单，修订后包括计算机辅助提醒和 50000 国际单位 D（2）的剂量。最初，基于计算机的 DI 比外科医生驱动的 AI（33%）更有效（P<.001）。引入计算机辅助提醒后，AI 的有效性提高到 68%。维生素 D 不足的明显流行再次证实了将维生素 D 建议纳入 Fx 护理途径的重要性。
