Ruths Sabine, Baste Valborg, Bakken Marit Stordal, Engesæter Lars Birger, Lie Stein Atle, Haugland Siren
Research Unit for General Practice, Uni Research Health, Bergen, Norway.
Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway.
BMC Health Serv Res. 2017 Feb 16;17(1):144. doi: 10.1186/s12913-017-2087-5.
Hip fractures represent major critical events for older people, and put huge demands on economic and personnel resources. Most hip fracture patients are in need of postoperative rehabilitation services. Through the Coordination Reform, the municipalities in Norway were given increased responsibility for community-based treatment and rehabilitation after surgery. The purpose of this study was to examine associations between municipal resources and patient outcomes through the first year after a hip fracture, focusing on survival and health-related quality of life.
We conducted a nationwide cohort study on people experiencing a hip fracture in 2011-2012 in Norway, with a 1-year follow-up. We obtained data on date of hip fracture, demographics, total morbidity (ASA) score, health-related quality of life (EQ-5D-3 L), date of death if applicable, municipality of residence (Norwegian Hip Fracture Register), date of hospital readmission due to complications (Norwegian Patient Register), and information on municipalities' characteristics (Municipality-State-Reporting).
The study population comprised 15,757 patients, mean age 80.8 years, 68.6% women. All-cause mortality was 8.6% at 30 days, and 25.3% at 12 months. Mortality was lower in the municipalities with the highest overall staff time for rehabilitation. A high proportion of the population aged 80+, was associated with low rates of self-reported anxiety/depression 12 months after surgery, as well as higher general health scores (EQ-5D VAS). There were no other differences in outcome according to rehabilitation resources, when comparing municipalities with the highest and lowest staffing.
The study revealed no substantial impact of municipal resources on survival and health-related quality of life through the first year after a hip fracture. To evaluate major organizational changes and allocate resources according to best practice, there is a need to monitor health outcomes and use of resources over time through reliable measures, including variables related to coordination between services.
髋部骨折对老年人来说是重大危急事件，对经济和人力资源提出了巨大需求。大多数髋部骨折患者需要术后康复服务。通过协调改革，挪威各市在术后基于社区的治疗和康复方面承担了更多责任。本研究的目的是通过髋部骨折后的第一年，研究市级资源与患者预后之间的关联，重点关注生存率和健康相关生活质量。
我们对2011 - 2012年在挪威发生髋部骨折的人群进行了一项全国性队列研究，并进行了为期1年的随访。我们获取了髋部骨折日期、人口统计学信息、总发病率（ASA）评分、健康相关生活质量（EQ - 5D - 3L）、适用时的死亡日期、居住市（挪威髋部骨折登记处）、因并发症再次入院日期（挪威患者登记处）以及各市特征信息（市 - 州报告）。
研究人群包括15757名患者，平均年龄80.8岁，68.6%为女性。30天时全因死亡率为8.6%，12个月时为25.3%。在康复总体工作人员时间最长的市，死亡率较低。80岁及以上人群比例较高与术后12个月自我报告的焦虑/抑郁率较低以及更高的总体健康评分（EQ - 5D视觉模拟量表）相关。在比较人员配备最高和最低的市时，根据康复资源，在结局方面没有其他差异。
该研究表明，在髋部骨折后的第一年，市级资源对生存率和健康相关生活质量没有实质性影响。为了评估重大组织变革并根据最佳实践分配资源，需要通过可靠的措施长期监测健康结局和资源使用情况，包括与服务协调相关的变量。
