González-Montalvo Juan I, Alarcón Teresa, Mauleón Jose L, Gil-Garay Enrique, Gotor Pilar, Martín-Vega Alberto
Department of Geriatrics, La Paz University Hospital, Madrid, Spain.
Hip Int. 2010 Apr-Jun;20(2):229-35. doi: 10.1177/112070001002000214.
We performed a prospective, quasi-experimental, randomised, interventional study comparing two models of care for patients admitted with osteoporotic hip fractures between February and August 2007 in a tertiary university hospital. The usual model of care was treatment of patients admitted to the orthopaedics ward, with consultation by the geriatrician (CG model). The study model involved admission to an acute orthogeriatric unit (OGU model), with joint care provided by geriatricians and orthopaedic surgeons which included immediate geriatric assessment, coordinated daily clinical care, weekly combined ward rounds, and joint planning of the surgical schedule, initial mobilisation, discharge date and destination. No differences were found between CG patients (123) and OGU patients (101) in terms of previous characteristics, number of patients surgically treated, functional level obtained, or discharge destination. OGU patients had earlier geriatric assessment (median 1 day, P25-P75: 1-2) than CG patients (median 4 days, P25-P75: 3-8), earlier surgery (median 5 days from admission to OGU, P25-P75: 3-6, versus 6 days in the CG group, P25-P75: 5-9), and had a shorter acute hospital stay (33% reduction, median 12 days in OGU, P25-P75: 9-14, versus 18 days, P25-P75: 13-23 in the CG group) and total (acute and subacute) hospital stay (30% reduction, median 14 days in OGU, P25-P75: 10-31, versus 20 days, P25-P75: 14-30 in the CG group). All these comparisons were statistically significant (p<0.01). The organization of an OGU in a tertiary hospital allowed hip fracture patients to receive earlier geriatric assessment and surgical treatment. Acute hospital stay was reduced by 33%, and total hospital stay was reduced by 30% with no differences at discharge in clinical and functional outcomes.
2007年2月至8月期间，我们在一家三级大学医院进行了一项前瞻性、准实验性、随机干预研究，比较了两种针对骨质疏松性髋部骨折入院患者的护理模式。常规护理模式是将患者收治到骨科病房，由老年病科医生会诊（CG模式）。研究模式是收治到急性老年骨科单元（OGU模式），由老年病科医生和骨科外科医生联合护理，包括立即进行老年病评估、协调日常临床护理、每周联合查房，以及共同制定手术时间表、初始活动计划、出院日期和出院目的地。在既往特征、接受手术治疗的患者数量、获得的功能水平或出院目的地方面，CG组患者（123例）和OGU组患者（101例）之间未发现差异。OGU组患者的老年病评估时间更早（中位数1天，P25 - P75：1 - 2），而CG组患者为（中位数4天，P25 - P75：3 - 8）；手术时间更早（从入院到OGU的中位数为5天，P25 - P75：3 - 6，而CG组为6天，P25 - P75：5 - 9）；急性住院时间更短（减少33%，OGU组中位数为12天，P25 - P75：9 - 14，而CG组为18天，P25 - P75：13 - 23），总（急性和亚急性）住院时间也更短（减少30%，OGU组中位数为14天，P25 - P75：10 - 31，而CG组为20天，P25 - P75：14 - 30）。所有这些比较均具有统计学意义（p<0.01）。在三级医院设立OGU可使髋部骨折患者更早接受老年病评估和手术治疗。急性住院时间减少了33%，总住院时间减少了30%，而出院时临床和功能结局无差异。
