Borade Amrut, Kempegowda Harish, Tawari Akhil, Suk Michael, Horwitz Daniel S
Department of Orthopaedic Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA 17822-2130, USA.
Department of Orthopaedic Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA 17822-2130, USA.
Injury. 2016 Dec;47(12):2755-2759. doi: 10.1016/j.injury.2016.10.011. Epub 2016 Oct 17.
Care gaps have been identified in the treatment of osteoporosis after the occurrence of a fragility hip fracture. HiROC (High Risk Osteoporosis Clinic) is a fracture liaison service implemented at our institution. In ProvenCare geriatric hip fracture care program at our institution pre-set orders for the inpatient HiROC consults were prescribed. We hypothesized that there will be a significant increase in the rate of enrollment of patients in the HiROC program after the integration of the pre-set orders.
The trauma database at a level-I trauma center was reviewed retrospectively for the charts of patients >50 years of age with fragility intertrochanteric fractures. Patients not treated under the geriatric hip fracture care program and patients treated under the geriatric hip fracture care program were identified and reviewed for the enrollment in HiROC and subsequent follow up.
Out of 589 patients treated before the implementation of ProvenCare, 443 patients (75%) were enrolled in HiROC at the index consult. In comparison, out of 153 patients treated after the implementation of ProvenCare, 131 patients (85.6%) were enrolled in HiROC at the index consult. The difference between the two groups was statistically significant (p=0.008).
Our experience shows that the occurrence of a fragility intertrochanteric fracture can be effectively utilized for the detection and initiation of treatment of osteoporosis. With the implementation of pre-set orders in the geriatric hip fracture care program significantly better enrollment can be achieved.
在脆性髋部骨折发生后，骨质疏松症的治疗中存在护理缺口。HiROC（高风险骨质疏松症诊所）是我们机构实施的一项骨折联络服务。在我们机构的ProvenCare老年髋部骨折护理计划中，为住院患者的HiROC咨询开了预先设定的医嘱。我们假设，在整合预先设定的医嘱后，HiROC计划的患者入组率将显著提高。
对一级创伤中心的创伤数据库进行回顾性审查，以获取年龄>50岁的脆性转子间骨折患者的病历。确定未在老年髋部骨折护理计划下接受治疗的患者以及在老年髋部骨折护理计划下接受治疗的患者，并审查他们在HiROC的入组情况及后续随访。
在ProvenCare实施前接受治疗的589例患者中，443例（75%）在首次咨询时入组HiROC。相比之下，在ProvenCare实施后接受治疗的153例患者中，131例（85.6%）在首次咨询时入组HiROC。两组之间的差异具有统计学意义（p=0.008）。
我们的经验表明，脆性转子间骨折的发生可有效用于骨质疏松症的检测和治疗启动。在老年髋部骨折护理计划中实施预先设定的医嘱，可以显著提高入组率。
