Department of Gerontology and Musculoskeletal Sciences, Bone Clinic, Galliera Hospital, Genoa, Italy.
Eur J Phys Rehabil Med. 2011 Jun;47(2):281-96. Epub 2011 May 10.
Hip fracture (HF) is a common event in the geriatric population and is often associated with significant morbidity, mortality and costs for the Healthcare Systems. The growing awareness of HF consequences and the expected rise in the total number of HF worldwide have led to the development and implementation of models of care alternative to the traditional ones for the acute and post-acute management of HF older adults. These services were set to minimize in-hospital complications, streamline hospital care and provide early discharge with the main objectives of improving functional and clinical outcomes, and reducing healthcare costs associated with hip and other fractures. Basically, the main feature that distinguishes these models is the different healthcare professional that retains the responsibility of the care during the acute and postacute phases. This review has been conceived to provide a brief description of the models implemented in the last twenty years, to describe their potential benefits on short- and long-term outcomes, to define the strengths and limitations of these models and the areas of uncertain, and to make some consideration about the future. Actually, on the basis of available studies, it is not possible to define the best model of care for HF older adults. However, the more complex and sophisticated services, characterized by a multidisciplinary approach demonstrated, in randomized-controlled and before-after observational studies, to produce better outcomes compared to the traditional or simplest models. Further research is warranted to confirm long-term functional and clinical benefits of these models and to evaluate their cost-effectiveness.
髋部骨折（HF）是老年人群中的常见事件，常与较高的发病率、死亡率和医疗保健系统成本相关。对 HF 后果的认识不断提高，以及全球 HF 总数预计将上升，这促使人们开发并实施了替代传统急性和康复期 HF 老年患者管理模式的护理模式。这些服务旨在减少院内并发症、简化医院护理并尽早出院，主要目标是改善功能和临床结局，并降低与髋部和其他骨折相关的医疗保健成本。基本上，这些模式的主要区别特征在于在急性和康复期阶段承担护理责任的不同医疗保健专业人员。本次综述旨在简要描述过去二十年来实施的模式，描述其对短期和长期结局的潜在益处，确定这些模式的优势和局限性以及不确定领域，并对未来进行一些考虑。实际上，根据现有研究，尚无法确定 HF 老年患者的最佳护理模式。然而，更复杂和精密的服务具有多学科方法的特点，随机对照和前后观察研究表明，与传统或最简单的模式相比，这些服务可产生更好的结局。需要进一步的研究来证实这些模式的长期功能和临床获益，并评估其成本效益。
