Bremen Hanne-Eva van, Kroes Thamar, Seppala Lotta J, Gans Emma A, Hegeman Johannes H, van der Velde Nathalie, Willems Hanna C
Amsterdam Bone Center, Movement Sciences Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands.
J Clin Med. 2024 Aug 6;13(16):4589. doi: 10.3390/jcm13164589.
: Integrated orthogeriatric care has demonstrated benefits in hip fracture management for older patients. Comprehensive care pathways are essential for effective integrated care delivery, yet local variability in care pathways persists. We assessed the current hip fracture care pathways in the Netherlands, focusing on the variability between these care pathways and the degree of implementation of orthogeriatric care. : A nationwide inventory study was conducted. A survey was sent to all hospitals in the Netherlands to collect the care pathways or local protocols for hip fracture care. All care elements reported in the care pathways and protocols were systematically analyzed by two independent researchers. Furthermore, an assessment was performed to determine which model of orthogeriatric care was applied. : All 71 Dutch hospitals were contacted, and 56 hospitals responded (79%), of which 46 (82%) provided a care pathway or protocol. Forty-one care elements were identified in total. In the care pathways and protocols, the variability in the description of these individual care elements ranged from 7% to 87%. Twenty-one hospitals had an integrated care model with shared responsibility, while an equal number followed an orthopedic trauma surgeon-led care model. : These findings provide a detailed description of the hip fracture care pathways in the Netherlands. Variations were observed concerning the care elements described in the care pathways, the structure of the care pathway, and the specification of several elements. The implementation of integrated care with shared responsibilities, as recommended by the international literature, has not been achieved nationwide. The clinical implications of the variability between care pathways, such as the influence on the quality of care, need to be further investigated.
综合老年骨科护理已证明对老年髋部骨折患者的治疗有益。全面的护理路径对于有效的综合护理提供至关重要，但护理路径的地区差异依然存在。我们评估了荷兰当前的髋部骨折护理路径，重点关注这些护理路径之间的差异以及老年骨科护理的实施程度。
开展了一项全国性清查研究。向荷兰所有医院发送了一份调查问卷，以收集髋部骨折护理的护理路径或当地方案。两名独立研究人员对护理路径和方案中报告的所有护理要素进行了系统分析。此外，还进行了一项评估，以确定采用了哪种老年骨科护理模式。
我们联系了荷兰所有71家医院，56家医院做出了回应（79%），其中46家（82%）提供了护理路径或方案。总共确定了41个护理要素。在护理路径和方案中，这些个别护理要素描述的差异范围为7%至87%。21家医院采用了共同负责的综合护理模式，而同样数量的医院遵循骨科创伤外科医生主导的护理模式。
这些发现详细描述了荷兰的髋部骨折护理路径。在护理路径中描述的护理要素、护理路径的结构以及几个要素的具体说明方面都存在差异。国际文献推荐的共同负责的综合护理在全国范围内尚未实现。护理路径差异的临床影响，如对护理质量的影响，需要进一步研究。
