西澳骨质疏松症护理模式的实施：利用急诊信息系统识别脆性骨折患者的骨折联络服务，以改善当前实践并降低再骨折率：为期 12 个月的分析。
Implementation of the Western Australian Osteoporosis Model of Care: a fracture liaison service utilising emergency department information systems to identify patients with fragility fracture to improve current practice and reduce re-fracture rates: a 12-month analysis.
机构信息
Sir Charles Gairdner and Osborne Park Health Care Group, Perth, Australia.
School of Medicine, The University of Western Australia, Perth, Australia.
出版信息
Osteoporos Int. 2018 Aug;29(8):1759-1770. doi: 10.1007/s00198-018-4526-5. Epub 2018 Apr 27.
UNLABELLED
Fracture liaison service linked to an emergency department database effectively identifies patients with OP, improves best practice care, reduces recurrent fractures, and improves quality of life (QoL). The next step is to establish cost-effectiveness. This should be seen as the standard model of care.
INTRODUCTION
The Western Australian Osteoporosis Model of Care recommends implementation of a fracture liaison service (FLS) to manage patients with minimal trauma fractures (MTFs). This study evaluates the efficacy of a FLS linked to a tertiary hospital emergency department information system (EDIS) in reducing recurrent fractures.
METHODS
Patients aged ≥ 50 years with MTF identified from EDIS were invited to the FLS. Patient outcomes were compared to routine care (retrospective group-same hospital, and prospective group-other hospital) at 3- and 12-month follow-up.
RESULTS
Two hundred forty-one of 376 (64.1%) eligible patients participated in the FLS with 12 months of follow-up. Absolute risk of recurrent MTF at 12 months was reduced by 9.2 and 10.2% compared with the prospective and retrospective controls, respectively. After age/sex adjustment, FLS participants had less MTF at 12 months vs. the retrospective controls, OR 0.38 (95%CI 0.18-0.79), but not the prospective controls, OR 0.40 (95%CI 0.16-1.01). FLS patients were more likely to receive the 'best practice' care, i.e. awareness of osteoporosis, investigations, and treatment (all p < 0.05). 'Fallers' (OR 0.48 (95%CI 0.24, 0.96)) and fall rates were lower in the FLS (p = 0.001) compared to the prospective control. FLS experienced the largest improvement in QoL from 3 to 12 months as measured by the EuroQoL 5-domain (EQ-5D) UK weighted score (+ 15 vs. - 11 vs. - 16%, p < 0.001) and EQ-5D Health State visual analogue scale (+ 29 vs. - 2 vs. + 1%, p < 0.001).
CONCLUSION
Patients managed in a linked EDIS-FLS were more likely to receive the 'best practice' care and had lower recurrent MTF and improved QoL.
目的
fracture liaison service（骨折联络服务）与急诊科数据库相关联，可有效识别患有骨质疏松症的患者，改善最佳实践护理，减少复发性骨折，并提高生活质量（QoL）。下一步是确定成本效益。这应被视为标准护理模式。
简介
西澳大利亚骨质疏松症护理模式建议实施骨折联络服务（FLS）来管理轻微创伤性骨折（MTFs）患者。本研究评估了与三级医院急诊科信息系统（EDIS）相关联的 FLS 在减少复发性骨折方面的功效。
方法
从 EDIS 中识别出年龄≥50 岁的 MTF 患者，邀请他们参加 FLS。在 3 个月和 12 个月的随访中，将患者的结果与常规护理（同一家医院的回顾性组和其他医院的前瞻性组）进行比较。
结果
241 名符合条件的患者中有 241 名（64.1%）参加了 FLS 并随访了 12 个月。与前瞻性和回顾性对照组相比，12 个月时复发性 MTF 的绝对风险分别降低了 9.2%和 10.2%。在年龄/性别调整后，与回顾性对照组相比，FLS 参与者 12 个月时的 MTF 发生率较低，OR 为 0.38（95%CI 0.18-0.79），但与前瞻性对照组无差异，OR 为 0.40（95%CI 0.16-1.01）。FLS 患者更有可能接受“最佳实践”护理，即骨质疏松症的意识、检查和治疗（均 p<0.05）。与前瞻性对照组相比，FLS 中的“跌倒者”（OR 0.48（95%CI 0.24, 0.96））和跌倒率更低（p=0.001）。与前瞻性对照组相比，FLS 在 3 个月至 12 个月期间的生活质量（通过 EuroQoL 5 维度（EQ-5D）英国加权评分测量）和 EQ-5D 健康状态视觉模拟量表（+15 比-11 比-16%，p<0.001）））有了最大的改善。
结论
在相关联的 EDIS-FLS 中管理的患者更有可能接受“最佳实践”护理，且复发性 MTF 发生率较低，生活质量得到改善。
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