Folbert E C Ellis, Smit Ruth S, van der Velde Detlef, Regtuijt E M Marlies, Klaren M Hester, Hegeman J H Han
Department of Surgery, ZGT Almelo, The Netherlands.
Geriatr Orthop Surg Rehabil. 2012 Jun;3(2):59-67. doi: 10.1177/2151458512444288.
Since April 1, 2008, patients aged ≥65 years presenting with a hip fracture at Ziekenhuisgroep Twente, Almelo (ZGT-A), The Netherlands, have been admitted to the geriatric fracture center (GFC) and treated according to the multidisciplinary treatment approach. The objective of this study was to evaluate how implementation of the treatment approach has influenced the quality of care given to older patients with hip fracture.
Prospective cohort study with historical control group.
Two groups of patients with hip fracture were compared, 1 group was treated according to the new multidisciplinary treatment approach in 2009-2010, and the other group received the usual treatment in 2007-2008. The number of readmissions within 30 days after discharge was compared, and an analysis was carried out regarding the number of complications, the number of consultations with various specialists and with the geriatrician, and the duration of hospital stay.
In all, 140 patients from 2009 to 2010 group and 90 patients from 2007 to 2008 group were included. In 2009-2010 group, the number of readmissions within 30 days dropped by 11 percentage points (P = .001). The incidence of the number of complications decreased with a median of 1 compared with 2007-2008 (P = .017) group. Delirium was diagnosed to be 6 percentage points more frequent. The median number of consultations with various specialists per patient decreased by 1 percentage point as a result of geriatrician cotreatment (P = .002). The median duration of hospital stay was 1 day shorter than that in 2007-2008 group.
The use of the multidisciplinary treatment approach led to a significant reduction in the number of readmissions within 30 days after discharge. It appears to be associated with improved short-term treatment outcomes for older patients with a hip fracture.
自2008年4月1日起，荷兰阿尔梅洛市特温特医院集团（ZGT - A）收治的65岁及以上髋部骨折患者被收入老年骨折中心（GFC），并按照多学科治疗方法进行治疗。本研究的目的是评估该治疗方法的实施对老年髋部骨折患者护理质量的影响。
设有历史对照组的前瞻性队列研究。
比较两组髋部骨折患者，一组在2009 - 2010年按照新的多学科治疗方法进行治疗，另一组在2007 - 2008年接受常规治疗。比较出院后30天内的再入院人数，并对并发症数量、与各专科医生和老年病医生的会诊次数以及住院时间进行分析。
总共纳入了2009至2010年组的140例患者和2007至2008年组的90例患者。在2009 - 2010年组中，30天内的再入院人数下降了11个百分点（P = .001）。并发症数量的发生率与2007 - 2008年组相比，中位数减少了1例（P = .017）。谵妄的诊断频率高出6个百分点。由于老年病医生共同治疗，每位患者与各专科医生的会诊中位数减少了1个百分点（P = .002）。住院时间中位数比2007 - 2008年组短1天。
多学科治疗方法的使用导致出院后30天内再入院人数显著减少。这似乎与老年髋部骨折患者短期治疗效果的改善有关。
