Department Clinical Nursing Science, University Hospital Basel, 4031 Basel, Switzerland.
Swiss Med Wkly. 2010 Aug 24;140:w13086. doi: 10.4414/smw.2010.13086. eCollection 2010.
PROBLEM AND QUESTIONS: The consequences for elderly patients with hip fractures are well known. In Switzerland, the introduction of diagnosis related groups (DRG) will bring additional challenges. New models of care, such as Geriatric Fracture Centres (GFC), may be the key to minimising negative outcomes. This study documents outcomes of hip fracture patients in the Swiss healthcare system, for use as baseline data prior to DRG- and GFC-implementation, and compares them to results reported in the literature, for example by Cooper (1997).
This was a prospective cohort quality assurance survey with a one-year follow-up. Outcomes were mortality, living situation, required support and mobility. All patients 65 years of age or older with a proximal femoral fracture were included. Data were analysed by descriptive and interferential statistics.
From 272 patients, 70% were community dwelling pre-fracture. Overall, one-year mortality was 22%. Pre-fracture community dwelling patients had better outcomes than nursing home patients with a one-year mortality rate of 12%. A total of 83% of pre-fracture community dwelling patients still lived in the community after one year but more needed help with activities of daily living (ADL) or mobility. Patients with dementia, ADL- and mobility dependency pre-fracture were significantly more at risk for being newly admitted to a nursing home.
Our results reflect the clinical reality of the hip fracture population in Switzerland. Results one year after fracture were comparable to study findings in different health care systems. Our findings provide important baseline data prior to the implementation of DRG and GFC.
髋部骨折老年患者的后果众所周知。在瑞士，引入诊断相关分组（DRG）将带来额外的挑战。老年骨折中心（GFC）等新的护理模式可能是将不良后果最小化的关键。本研究记录了瑞士医疗保健系统中髋部骨折患者的结局，作为 DRG 和 GFC 实施前的基线数据，并与 Cooper（1997 年）等文献报告的结果进行了比较。
这是一项前瞻性队列质量保证调查，随访时间为 1 年。结局为死亡率、居住情况、所需支持和活动能力。所有年龄≥65 岁、股骨近端骨折的患者均纳入研究。采用描述性和干预性统计方法对数据进行分析。
在 272 例患者中，70%在骨折前居住在社区。总的来说，1 年死亡率为 22%。骨折前居住在社区的患者比住在养老院的患者预后更好，1 年死亡率为 12%。骨折前居住在社区的患者中，83%的患者在 1 年后仍居住在社区，但更多的患者需要帮助日常生活活动（ADL）或移动。骨折前有痴呆、ADL 和移动依赖的患者入住养老院的风险明显更高。
我们的结果反映了瑞士髋部骨折人群的临床实际情况。骨折 1 年后的结果与不同医疗保健系统的研究结果相当。我们的研究结果为实施 DRG 和 GFC 前提供了重要的基线数据。
