Level 3, John Hunter Hospital, Hunter New England Area Health Service, Locked Bag 1, Hunter Region Mail Centre (HRMC), Newcastle, NSW, 2310, Australia.
Osteoporos Int. 2011 Aug;22(8):2321-8. doi: 10.1007/s00198-010-1466-0. Epub 2010 Nov 3.
The implementation of a multidisciplinary team-based model of care has led to significant increases in identification of patients with osteoporosis who are at risk of refracture, together with improved treatment uptake and ongoing management.
Osteoporosis-related fractures and consequent hospital admissions are largely preventable; however, little attention has been paid to how to achieve this, in particular, through improved models of care. Presentation to emergency departments (ED) with minimal trauma fracture (MTF) provides opportunity for patients at risk to be identified, referred and managed through a systematic process ensuring prompt intervention and continuing follow-up. This study is aimed to design and implement a care model for people over 50 years of age, presenting to ED with an MTF.
Established a multidisciplinary fracture prevention team to identify and capture at-risk patients for referral and management. Clinical data revealed the extent of lost opportunities. An electronic flagging system and data acquisition tool were developed and piloted. Established a referral pathway to detect, manage and follow-up patients, coordinated by a fracture prevention nurse.
Increased awareness of osteoporosis as a cause of MTF, better identification of at-risk patients across departments and services and development of a flagging and referral protocol has resulted in 100% capture of at-risk patients presented to ED. As a result there has been a significant increase in patients attending the fracture prevention clinic (FPC) (p < 0.001) from 11% in 2007 to 29% in 2008 and a significantly reduced time between fracture and when patients are seen in the FPC (p < 0.001).
A multipronged systematic team approach to identifying and capturing patients with a high risk of refracture and a dedicated nurse coordinator role has created efficiencies in the detection and management of osteoporosis.
描述一种多学科团队为基础的管理模式的实施，该模式显著提高了骨质疏松症高危患者的检出率，改善了治疗的实施和持续管理。
骨质疏松症相关骨折及其导致的住院治疗在很大程度上是可以预防的，然而，人们很少关注如何实现这一目标，特别是通过改善管理模式。在因最小创伤性骨折(minimal trauma fracture，MTF)而就诊于急诊科(emergency department，ED)的患者中，提供了一个识别、转介和管理高危患者的机会，通过一个系统的流程来确保及时干预和持续随访。本研究旨在为因 MTF 而就诊于 ED 的 50 岁以上患者设计并实施一种管理模式。
建立了一个多学科的骨折预防团队，以识别和捕捉高危患者进行转介和管理。临床数据揭示了错失的机会的程度。开发并试点了一个电子标记系统和数据采集工具。建立了一条转诊途径，以发现、管理和随访患者，由一名骨折预防护士进行协调。
提高了对 MTF 为骨质疏松症病因的认识，改善了跨科室和服务的高危患者的识别，并制定了标记和转诊方案，使 100%的高危患者在 ED 就诊时被捕获。因此，到骨折预防诊所(fracture prevention clinic，FPC)就诊的患者显著增加(从 2007 年的 11%增加到 2008 年的 29%)(p<0.001)，且骨折和患者在 FPC 就诊之间的时间明显缩短(p<0.001)。
一种多管齐下的系统团队方法，用于识别和捕获高危骨折患者，并设立专门的护士协调员角色，提高了骨质疏松症的检测和管理效率。
