Department of Orthopaedic and Traumatology, Beijing Jishuitan Hospital, Beijing, China.
The George Institute for Global Health, Peking University Health Science Center, Beijing, China.
Arch Osteoporos. 2019 Mar 22;14(1):43. doi: 10.1007/s11657-019-0594-1.
Hip fracture becomes a major public health issue with the growing aging population. This study evaluated a multidisciplinary co-management program for older hip fracture patients and found it significantly improved the best practice indicators. It provided preliminary evidence to support the use of such intervention in hip fracture management.
PURPOSE/INTRODUCTION: Hip fracture leads to high morbidity and mortality in older people. A previous study found a significant disparity in hip fracture management in Beijing Jishuitan Hospital (JSTH) compared to best practice care in the United Kingdom (UK). Following this audit, JSTH launched a multidisciplinary co-management care plan for older hip fracture patients. This study aims to evaluate the effect of this program on the six standards recommended in the UK hip fracture best practice guidelines.
In this retrospective study, electronic medical record data were collected before and after the intervention. Eligible patients were aged ≥ 65 years, had X-ray confirmed hip fracture, and were admitted to JSTH within 30 days of injury. Patient demographic information, time from emergency department presentation to admission, time from admission to surgery, pressure ulcers, osteoporosis assessment, and falls prevention were collected. Multivariable logistic and median regression models were used for binary and continuous outcomes respectively. Segment regression was also performed for time-related outcomes.
A total of 3540 eligible patients were identified. After the intervention, half of the patients who received co-management received surgery within 48 h of ward admission compared to 6.4% previously, 0.3% (vs 1.4%) developed pressure ulcers, and 76% (vs 19%) received osteoporosis assessment. No significant differences were observed in fall assessment rates. However, there was a higher rate of ward admission within 4 h of arrival in emergency for patients admitted pre-intervention (61% vs 34%).
The introduction of the co-management model significantly reduced the time from admission to surgery and improved other practice outcomes. A multicenter randomized controlled trial is needed to evaluate the impact of this model on patient health outcomes.
目的/介绍：老年人髋部骨折可导致高发病率和死亡率。先前的一项研究发现，北京积水潭医院（JSTH）在髋部骨折管理方面与英国（UK）的最佳实践护理存在显著差异。在此次审核之后，JSTH 为老年髋部骨折患者推出了多学科联合管理护理计划。本研究旨在评估该计划对英国髋部骨折最佳实践指南中推荐的 6 项标准的影响。
在这项回顾性研究中，收集了干预前后的电子病历数据。符合条件的患者年龄≥65 岁，经 X 光证实患有髋部骨折，且在受伤后 30 天内入住 JSTH。收集患者的人口统计学信息、从急诊就诊到入院的时间、从入院到手术的时间、压疮、骨质疏松评估和跌倒预防情况。使用多变量逻辑回归和中位数回归模型分别对二分类和连续结果进行分析。对于时间相关结果，还进行了分段回归。
共确定了 3540 名符合条件的患者。干预后，接受联合管理的患者中有一半在入院后 48 小时内接受了手术，而之前这一比例为 6.4%，发生压疮的比例为 0.3%（之前为 1.4%），接受骨质疏松评估的比例为 76%（之前为 19%）。跌倒评估率没有显著差异。然而，与接受干预前相比，入院后 4 小时内到达急诊的患者的入院率更高（61% 对 34%）。
联合管理模式的引入显著缩短了从入院到手术的时间，并改善了其他实践结果。需要进行多中心随机对照试验来评估该模式对患者健康结果的影响。
