Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
Department of Trauma Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
Age Ageing. 2021 Sep 11;50(5):1744-1750. doi: 10.1093/ageing/afab031.
Hip fractures are a major cause of mortality and disability in frail older adults. Therefore, orthogeriatrics has been embraced to improve patient outcomes. With the optimal template of orthogeriatric care still unknown, and to curtail rising healthcare expenditure we implemented a nurse practitioner-led orthogeriatric care program (NPOCP). The objective was to evaluate NPOCP by measuring 3-month and 1-year mortality, compared to usual care (UC). In addition, length of stay (LOS) and location of hospital discharge were reported.
An anonymised data set, of hip fracture patients (n = 300) who presented to Maastricht University Medical Centre, the Netherlands, a level-1 trauma centre, was used. NPOCP was implemented on one of two surgical wards, while the other ward received UC. Patient allocation to these wards was random.
In total, 144 patients received NPOCP and 156 received UC. In the NPOCP, 3-month and 1-year mortality rates were 9.0% and 13.9%, compared to 24.4% and 34.0% in the UC group (P < 0.001). The adjusted hazard ratio (aHR) for 3-month (aHR 0.50 [95%CI: 0.26-0.97]) and 1-year mortality (aHR 0.50 [95%CI: 0.29-0.85]) remained lower in NPOCP compared to UC. Median LOS was 9 days [IQR 5-13] in patients receiving UC and 7 days [IQR 5-13] in patients receiving NPOCP (P = 0.08). Thirty-eight (27.5%) patients receiving UC and fifty-seven (40.4%) patients receiving NPOCP were discharged home (P = 0.023).
Implementation of NPOCP was associated with significantly reduced mortality in hip fracture patients and may contribute positively to high-quality care and improve outcomes in the frail orthogeriatric population.
髋部骨折是体弱老年人死亡和残疾的主要原因。因此，矫形老年医学已被采纳，以改善患者的预后。由于最佳矫形老年医学护理模式仍不清楚，为了控制不断上升的医疗保健支出，我们实施了以护士从业者为基础的矫形老年医学护理计划（NPOCP）。其目的是通过测量 3 个月和 1 年的死亡率，与常规护理（UC）相比，来评估 NPOCP。此外，还报告了住院时间（LOS）和出院地点。
使用荷兰马斯特里赫特大学医学中心（一个 1 级创伤中心）的髋部骨折患者（n=300）匿名数据集。NPOCP 实施在两个外科病房之一，而另一个病房则接受 UC。患者被随机分配到这些病房。
总共有 144 名患者接受了 NPOCP，156 名患者接受了 UC。在 NPOCP 组中，3 个月和 1 年的死亡率分别为 9.0%和 13.9%，而 UC 组分别为 24.4%和 34.0%（P<0.001）。3 个月（调整后的危险比[aHR]0.50[95%CI：0.26-0.97]）和 1 年死亡率（aHR 0.50[95%CI：0.29-0.85]）的调整后 HR 在 NPOCP 中仍低于 UC。接受 UC 的患者的 LOS 中位数为 9 天[IQR 5-13]，接受 NPOCP 的患者为 7 天[IQR 5-13]（P=0.08）。38 名（27.5%）接受 UC 的患者和 57 名（40.4%）接受 NPOCP 的患者被送回家（P=0.023）。
实施 NPOCP 可显著降低髋部骨折患者的死亡率，并可能对虚弱的矫形老年人群的高质量护理和改善预后产生积极影响。
