Division of Hospital Medicine, Department of Medicine, Northwell Health, Manhasset, New York, USA.
Division of Geriatrics and Palliative Medicine, Department of Medicine, Northwell Health, Manhasset, New York, USA.
J Am Geriatr Soc. 2020 Aug;68(8):1706-1713. doi: 10.1111/jgs.16483. Epub 2020 May 11.
Acute hip fracture is common and leads to significant morbidity and mortality. Co-management programs, such as American Geriatric Society (AGS) CoCare: Ortho®, that optimize perioperative care of older adults, have demonstrated improved outcomes. Yet there is substantial variation in hip fracture care nationally. Our objective was to describe the implementation of AGS CoCare: Ortho® across a large integrated health system.
Program implementation of four phases.
Large integrated health system.
One tertiary and three community hospitals.
The first two phases were communication and system-level planning. The communication phase consisted of getting health system leadership buy-in, creating an interdisciplinary steering committee, and building a business model. The planning phase consisted of choosing process and outcome measures, ensuring accurate and timely data collection, and creating standardized order sets and physician documentation.
The second two phases were hospital-level planning and implementation. The planning phase consisted of identifying sites and developing the co-management structure. The implementation phase consisted of identifying and engaging frontline staff, rolling out the program, optimizing workflow, and educating providers.
The program was implemented at four diverse sites. Major lessons learned included the need for an engaged steering committee to oversee the program; the importance of standardizing order sets and documentation; the utilization of hospitalists as co-managers; the benefit of developing and actively using a data dashboard; the challenge of ensuring wide uptake of education modules; and the need to take proactive steps to improve multidisciplinary communication. J Am Geriatr Soc 68:1706-1713, 2020.
髋部急性骨折较为常见，可导致较高的发病率和死亡率。诸如美国老年学会（AGS）CoCare：Orth o® 等联合管理计划通过优化老年人围手术期护理，已证实可改善预后。但全国髋部骨折治疗情况存在较大差异。本研究旨在描述美国老年学会 CoCare：Orth o® 在大型综合医疗系统中的实施情况。
分四个阶段实施项目。
大型综合医疗系统。
一家三级医院和三家社区医院。
前两个阶段为沟通和系统层面的计划。沟通阶段包括获得医疗系统领导层的认可、创建跨学科指导委员会和建立商业模式。计划阶段包括选择过程和结果测量指标、确保准确和及时的数据收集以及创建标准化医嘱和医生文档。
后两个阶段为医院层面的计划和实施。计划阶段包括确定地点并制定联合管理结构。实施阶段包括确定和培训一线工作人员、推出该项目、优化工作流程以及培训医生。
该项目在四个不同的地点实施。主要经验教训包括需要一个积极参与的指导委员会来监督该项目；标准化医嘱和文档的重要性；将医院医生作为联合管理者的利用；开发和积极使用数据仪表盘的益处；确保广泛采用教育模块的挑战；以及积极采取措施改善多学科沟通的必要性。
美国老年学会杂志 68:1706-1713, 2020。
