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通过多学科联合管理方案改善老年股骨近端骨折的治疗效果并降低医疗费用:一项为期一年的回顾性研究。

Improved outcomes and reduced medical costs through multidisciplinary co-management protocol for geriatric proximal femur fractures: a one-year retrospective study.

机构信息

Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan.

School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.

出版信息

BMC Geriatr. 2022 Apr 11;22(1):318. doi: 10.1186/s12877-022-03014-6.

Abstract

BACKGROUND

To manage the rapidly growing incidence of, and related medical burden resulting from hip fractures in older adults in an aging society, studies involving orthogeriatric co-management treatment models have reported improved outcomes, including reduced medical costs. The treatment gap for osteoporosis was however seldom emphasized in the published treatment protocols. Aiming to improve the existing orthogeriatric protocol, we have established a patient-centered protocol for elderly patient hip fractures, which simultaneously focuses on fracture care and anti-osteoporosis agent prescription in regarding to healthcare quality and medical expense.

METHODS

This was a retrospective study comparing patients who enrolled in the multidisciplinary co-managed protocol for geriatric hip fractures and those who did not. The inclusion criteria for this study were: (a) single-sided hip fractures treated from 1 to 2018 to 30 June 2020, (b) patients who were 60-years or older (c) trauma treated within 3 days from time of injury, and (d) minimal follow-up period of 12 months after surgery.

RESULTS

From 1 to 2018 to 30 June 2020, 578 patients were included (267 patients in the protocol group vs. 331 patients in the conventional group). The protocol group was associated with significantly reduced lengths of hospital stay (p = 0.041), medical expenditures (p = 0.006), and mortality (p = 0.029) during their acute in-hospital admission period. Early osteoporosis diagnosis and anti-osteoporosis agent prescription were achieved in the protocol group, with a significantly wider coverage for BMD assessment (p < 0.001) and prescriptions for anti-osteoporosis medication (p < 0.001). Yet, there was no significant decline in the one-year refracture rate in the protocol group.

CONCLUSIONS

The implementation of a multidisciplinary co-managed care protocol for geriatric proximal femur fractures successfully improved patient outcomes with significantly reduced lengths of stay, medical expenditures, and mortality during the acute in-hospital admission period. The high prescription rate of anti-osteoporosis medication after hip fractures in the protocol group was not associated with a significantly lower re-fracture rate in the 12-month follow-up. However, the association between early anti-osteoporosis agent prescription and reduced long-term medical expenses in this group of patients has provided a direction for future research.

摘要

背景

在老龄化社会中,老年人髋部骨折的发病率和相关医疗负担迅速增加,涉及矫形骨科联合管理治疗模式的研究报告称,该治疗模式可改善预后,包括降低医疗成本。然而,在已发表的治疗方案中,骨质疏松治疗差距很少被强调。为了改善现有的矫形骨科协议,我们为老年髋部骨折患者制定了一个以患者为中心的协议,该协议同时关注骨折护理和抗骨质疏松药物处方,以提高医疗质量和医疗费用。

方法

这是一项回顾性研究,比较了参加老年髋部骨折多学科联合管理协议的患者和未参加的患者。本研究的纳入标准为:(a)1 年至 2018 年 6 月 30 日单侧髋部骨折;(b)年龄 60 岁或以上;(c)创伤在受伤后 3 天内接受治疗;(d)术后随访至少 12 个月。

结果

2018 年 1 月至 2018 年 6 月 30 日期间,共纳入 578 例患者(协议组 267 例,常规组 331 例)。协议组患者的住院时间(p=0.041)、医疗费用(p=0.006)和死亡率(p=0.029)在急性住院期间显著降低。协议组早期诊断骨质疏松症并开具抗骨质疏松药物,BMD 评估(p<0.001)和抗骨质疏松药物处方(p<0.001)的覆盖率显著增加。然而,协议组 1 年内再骨折率并未显著下降。

结论

为老年股骨近端骨折实施多学科联合管理护理协议,可显著降低急性住院期间的住院时间、医疗费用和死亡率,从而改善患者预后。协议组髋部骨折后抗骨质疏松药物的高处方率与 12 个月随访时再骨折率的降低无显著相关性。然而,该组患者早期抗骨质疏松药物处方与长期医疗费用降低之间的关联为今后的研究提供了方向。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3746/8996524/1c5e4efa46ce/12877_2022_3014_Fig1_HTML.jpg

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