Scott & White Memorial Hospital and Clinic, The Texas A&M University Health Science Center College of Medicine, Temple, TX, USA.
J Orthop Trauma. 2011 Feb;25(2):72-5. doi: 10.1097/BOT.0b013e3181db703c.
To develop an initiative using standardized discharge orders to improve the posthip fracture care of patients aged 50 years or older.
Prospective nonrandomized study.
Hospital orthopaedic service.
Patients at our institution older than age 50 years sustaining a hip fracture who were followed for at least 6 months and qualified for osteoporosis medication.
The endocrinology and orthopaedic areas agreed to add calcium/vitamin D supplementation, a dual-energy x-ray absorptiometry scan request, and a consult with endocrinology to the hospital discharge orders.
The proportions of patients using calcium or bisphosphonate before and after the intervention were compared using the McNemar test. The designated level of significance was 0.05.
Originally, 37 of 137 patients were taking calcium/vitamin D supplements. Following this initiative, 92 of 137 were taking the supplement (P < 0.0001). Seventeen of 137 patients were taking bisphosphonate initially and 65 of 137 after the initiative (P < 0.0001). After the initiative, 100% of the discharged patients were offered calcium/vitamin D, a dual-energy x-ray absorptiometry scan, and an endocrinology appointment. All of the patients who reported for the endocrinology consult appointment were offered bisphosphonate therapy. Eighty-two patients kept the appointment for the dual-energy x-ray absorptiometry scan, and 54 saw the endocrinologist.
The addition of a calcium/vitamin D supplement and an endocrinology appointment to the hospital discharge orders was an effective method of improving treatment and enhancing compliance.
制定一项使用标准化出院医嘱的方案，以改善 50 岁及以上髋部骨折患者的骨折后护理。
前瞻性非随机研究。
医院骨科。
我院年龄 50 岁以上、至少随访 6 个月且符合骨质疏松症药物治疗条件的髋部骨折患者。
内分泌科和骨科同意在医院出院医嘱中增加钙/维生素 D 补充剂、双能 X 线吸收仪扫描请求和内分泌科会诊。
使用 McNemar 检验比较干预前后使用钙或双膦酸盐的患者比例。指定的显著性水平为 0.05。
最初，137 名患者中有 37 名服用钙/维生素 D 补充剂。在这一举措之后，137 名患者中有 92 名服用了补充剂（P<0.0001）。最初有 17 名患者服用双膦酸盐，在该方案后有 65 名患者服用双膦酸盐（P<0.0001）。在该方案后，100%出院的患者都被提供了钙/维生素 D、双能 X 线吸收仪扫描和内分泌科就诊。所有报告接受内分泌科会诊的患者都被提供了双膦酸盐治疗。82 名患者预约了双能 X 线吸收仪扫描，54 名患者看了内分泌科医生。
在医院出院医嘱中增加钙/维生素 D 补充剂和内分泌科会诊是改善治疗和提高依从性的有效方法。
