Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
Osteoporos Int. 2010 Dec;21(Suppl 4):S621-5. doi: 10.1007/s00198-010-1417-9. Epub 2010 Nov 6.
Hip fractures in older adults are a common event with a high risk of morbidity and mortality. Patients who sustain a hip fracture often present with multiple co-morbid conditions that can benefit from co-management by orthopedic surgeons and geriatricians. This manuscript describes a co-managed model of care for patients with hip fractures. This model of care will be explained, and the benefits and results will be described. Retrospective review of the care of all native non-pathological hip fracture patients aged 60 years and older admitted between April 2005 and March 2009 to a 261-bed community teaching hospital. The outcome measures include patient characteristics, length of stay, mortality, 30-day readmission, re-operation, and costs of care. Seven hundred fifty-eight patients were identified with an average age of 84.8 (SD 8.4); 77.8% of the patients were female, 94.7% Caucasian, and 37.3% from nursing homes, and the mean Charlson score is 2.9 (SD 2.1). The length of stay was 4.3 days, 30-day readmission rate was 10.4%, 17-month re-operation rate was 1.9%, and costs of care to the system were $15,188. The 1-year mortality rate was 21.2%. This model of care resulted in improvements in all measures studied. Previous studies have shown reduction in in-hospital complications. Additional studies are needed to show if this model of care can be translated to other systems or to other surgical conditions. Wide application of this model care could substantially improve the quality of care and cost of caring for frail elders with hip fractures.
老年人髋部骨折是一种常见的疾病，具有较高的发病率和死亡率。患有髋部骨折的患者通常存在多种合并症，这些合并症可以通过骨科医生和老年病医生的共同管理得到改善。本文介绍了一种髋部骨折患者的共同管理护理模式。将对这种护理模式进行解释，并描述其优点和结果。对 2005 年 4 月至 2009 年 3 月期间入住一家拥有 261 张床位的社区教学医院的所有年龄在 60 岁及以上的非病理性原发性髋部骨折患者的护理进行回顾性研究。评估指标包括患者特征、住院时间、死亡率、30 天再入院率、再手术率和护理成本。共确定了 758 名患者，平均年龄为 84.8 岁（标准差 8.4）；77.8%的患者为女性，94.7%为白种人，37.3%来自养老院，Charlson 评分平均为 2.9（标准差 2.1）。住院时间为 4.3 天，30 天再入院率为 10.4%，17 个月再手术率为 1.9%，系统护理成本为 15188 美元。1 年死亡率为 21.2%。这种护理模式改善了所有研究指标。先前的研究表明，这种护理模式可减少住院并发症。还需要进一步的研究来证实这种护理模式是否可以推广到其他系统或其他手术条件。广泛应用这种护理模式可以显著提高对髋部骨折脆弱老年人的护理质量和成本效益。
