Janssens Sigrid, Luyten Jeroen, Deschodt Mieke, Sermon An, Flamaing Johan, Dejaeger Marian
Department of Public Health and Primary Care, Division of Gerontology and Geriatrics, KU Leuven, Herestraat 49, 3000, Louvain, Belgium.
Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Louvain, Belgium.
Osteoporos Int. 2025 Jul 14. doi: 10.1007/s00198-025-07608-9.
This study evaluated six orthogeriatric care models for older fracture patients in Belgium. Integrated care on surgical wards reduced emergency department visits, while consultation on request on geriatric wards yielded the highest survival. All models had comparable costs except for integrated care on a geriatric ward, which was more expensive.
This study assessed the (cost-)effectiveness of systematic collaboration (systematic consultation or integrated care) between surgical and geriatric teams compared to consultation on request in Belgium.
This registry-based study included patients aged ≥ 75 years admitted with hip, pelvis, wrist, shoulder, or vertebral fractures in 2019. We compared six care models: consultation on request, systematic consultation, or integrated care, on either surgical or geriatric wards. The primary outcome was 1-year mortality. Secondary outcomes included 30- and 90-day mortality, 1-year survival time, length of stay (LOS), 30- and 90-day emergency department (ED) visits and unplanned readmissions, and 1-year institutionalization. Cost-effectiveness was assessed using survival time and total direct costs within one year.
We analyzed 8,302 patients across 60 hospitals. LOS was shortest for consultation on request on surgical (10 days) and geriatric wards (12 days), and for integrated care on a surgical ward (11 days). ED visits at 30 (5.9%) and 90 days (11.0%) were lowest for integrated care on a surgical ward. Survival time was highest for consultation on request on a geriatric ward. Mortality, institutionalization, and unplanned readmissions were similar across models. Costs were mostly comparable (€16,445-€17,829) except for integrated care on a geriatric ward, which was more expensive (€18,726).
Integrated care on a surgical ward reduced ED visits without compromising outcomes. While consultation on request on a geriatric ward showed the highest survival time at similar cost, absolute differences were minimal, thereby emphasizing the overall health-economic comparability across models.
本研究评估了比利时针对老年骨折患者的六种骨科老年护理模式。外科病房的综合护理减少了急诊就诊次数，而老年病房的按需会诊生存率最高。除了老年病房的综合护理成本更高外，所有模式的成本相当。
本研究评估了比利时外科团队和老年团队之间系统协作（系统会诊或综合护理）与按需会诊相比的（成本）效益。
这项基于登记处的研究纳入了2019年因髋部、骨盆、腕部、肩部或脊椎骨折入院的75岁及以上患者。我们比较了六种护理模式：外科或老年病房的按需会诊、系统会诊或综合护理。主要结局是1年死亡率。次要结局包括30天和90天死亡率、1年生存时间、住院时间（LOS）、30天和90天急诊就诊次数及非计划再入院次数，以及1年机构化情况。使用生存时间和1年内的总直接成本评估成本效益。
我们分析了60家医院的8302例患者。外科病房（10天）和老年病房（12天）的按需会诊以及外科病房的综合护理（11天）住院时间最短。外科病房的综合护理在30天（5.9%）和90天（11.0%）的急诊就诊率最低。老年病房的按需会诊生存时间最长。各模式的死亡率、机构化情况和非计划再入院次数相似。成本大多相当（16445欧元至17829欧元），除了老年病房的综合护理成本更高（18726欧元）。
外科病房的综合护理减少了急诊就诊次数且不影响治疗效果。虽然老年病房的按需会诊在成本相似的情况下生存时间最长，但绝对差异很小，从而强调了各模式在整体卫生经济方面的可比性。
