高风险骨质疏松症诊所（HiROC）：采用有组织、系统性的方法改善骨质疏松症及骨折后护理。
High-risk osteoporosis clinic (HiROC): improving osteoporosis and postfracture care with an organized, programmatic approach.
作者信息
Olenginski T P, Maloney-Saxon G, Matzko C K, Mackiewicz K, Kirchner H L, Bengier A, Newman E D
机构信息
Department of Rheumatology, Geisinger Medical Center, MC 21-52, 100 North Academy Avenue, Danville, PA, 17822, USA,
出版信息
Osteoporos Int. 2015 Feb;26(2):801-10. doi: 10.1007/s00198-014-2967-z. Epub 2014 Nov 15.
SUMMARY
A programmatic outpatient high-risk osteoporosis clinic (outpatient HiROC) and inpatient fracture liaison service (inpatient HiROC) is described. Results document that this population is more effectively treated and followed up in this specialty pathway than with primary care follow-up.
INTRODUCTION
We describe a programmatic approach to outpatient care of high-risk osteoporosis patients (outpatient HiROC). We similarly describe an inpatient fracture liaison service (inpatient HiROC), which integrates into the existing outpatient HiROC pathway.
METHODS
The development of outpatient HiROC and inpatient HiROC is described. Outpatient visits (July 29, 2008 to October 27, 2011) are included with a 200 patients random sample calculation. Inpatient consultation visits between November 18, 2008 and October 27, 2011 are included.
RESULTS
Between July 29, 2008 and December 31, 2011, 1917 outpatient consults were seen. Of the 200 patient samples, 87% were female, mean age of 69.8 years, previous fractures occurred in 34% patients, and glucocorticoid users constituted 10.6%. Eighty-six percent of this group was high risk, where drug therapy is indicated, and such treatment was started in 89%. A total of 1041 inpatient fracture consults were seen during the evaluable period; 14.7% of this population died before the 6-month follow-up. Females comprised 77.6%, mean age was 76.1 years, and 58.2% of fractures were hip fragility, 11.6% vertebral, and 1.7% midshaft and 1.6% subtrochanteric. Patients seen in our outpatient HiROC pathway were significantly more likely to be treated than those followed up by one of our primary care doctors (80.6 versus 32.2%, P<0.0001). Mean vitamin D levels at baseline (27.0 ng/mL) improved to 34.6 ng/mL at 6-month follow-up (P<0.0001).
CONCLUSIONS
Our outpatient and inpatient HiROC model is efficient and effective in risk stratifying and treating patients at high risk for fractures.
摘要
本文描述了一个门诊高危骨质疏松症诊疗项目（门诊HiROC）和住院骨折联络服务（住院HiROC）。结果表明，相较于初级保健随访，在这个专科诊疗路径中，该人群能得到更有效的治疗和随访。
引言
我们描述了一种针对高危骨质疏松症患者的门诊护理项目方法（门诊HiROC）。我们同样描述了一种住院骨折联络服务（住院HiROC），它整合到现有的门诊HiROC路径中。
方法
描述了门诊HiROC和住院HiROC的发展情况。纳入了门诊就诊（2008年7月29日至2011年10月27日），并进行了200例患者的随机抽样计算。纳入了2008年11月18日至2011年10月27日期间的住院会诊。
结果
在2008年7月29日至2011年12月31日期间，共进行了1917次门诊咨询。在200例患者样本中，87%为女性，平均年龄69.8岁，34%的患者曾发生过骨折，使用糖皮质激素的患者占10.6%。该组中86%为高危患者，需要进行药物治疗，其中89%开始了此类治疗。在可评估期间，共进行了1041次住院骨折咨询；该人群中有14.7%在6个月随访前死亡。女性占77.6%，平均年龄76.1岁，58.2%的骨折为髋部脆性骨折，11.6%为椎体骨折，1.7%为骨干骨折，1.6%为转子下骨折。在我们的门诊HiROC路径中就诊的患者比由我们的一名初级保健医生随访的患者更有可能接受治疗（80.6%对32.2%，P<0.0001）。基线时平均维生素D水平（27.0 ng/mL）在6个月随访时提高到34.6 ng/mL（P<0.0001）。
结论
我们的门诊和住院HiROC模式在对骨折高危患者进行风险分层和治疗方面是高效且有效的。
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