Impact of an orthogeriatric collaborative care model for older adults with hip fracture in a community hospital setting.
Impact of an orthogeriatric collaborative care model for older adults with hip fracture in a community hospital setting.
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DOI：
10.1503/cjs.001720
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发表时间：
2021-03-26
期刊：
影响因子：
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通讯作者：
Wong CL
中科院分区：
文献类型：
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作者：
Lee JC;Koo K;Wong EKC;Naqvi R;Wong CL
研究表明，如果髋部骨折的老年人得到一个提供全面老年评估的多学科团队的护理，术后精神错乱的发生率、住院时间和手术时间都会减少。这些研究大多是在学术中心进行的。我们试图确定实施正畸协作护理模式是否会改善社区医院环境中的关键护理质量指标。这项干预前后的单部位回顾性研究是在加拿大安大略省的一家社区医院进行的。我们包括连续的65岁或65岁以上的患者，他们在2015年6月至2017年6月期间因髋部骨折而住院。在干预期间，新的术后顺序集包括转诊至老年医生进行全面的老年评估，并直接执行建议。主要结果是术后精神错乱的发生率和住院时间。次要结果包括安大略省的健康质量髋部骨折的质量标准。共有212名连续患者(干预前组95人，干预后组117人)纳入研究。干预前和干预后两组的术后妄想发生率(26.3%vs26.5%，p=0.98)和住院时间(四分位间隔4-10 vs5-10 d，p=0.32)相似。在精神状态、跌倒和骨骼健康的评估率方面有改善(p<；0.001)；确定精神错乱的预防策略；处方维生素D或钙或两者兼而有之；以及抗吸收治疗的建议。尽管系统地实施了正畸模型，但在干预后组中，只有74.4%的患者接受了老年医学顾问的治疗。尽管对髋部骨折的老年人实施正畸协作护理模式并没有减少术后精神错乱的发生率或住院时间，但达到髋部骨折护理的其他几个关键质量标准的比率有所改善。在社区医院环境中进行更早的积极、全面的老年评估将是进一步提高质量倡议的目标。
Studies have shown that the incidence of postoperative delirium, the hospital length of stay and time to surgery are reduced when older adults with a hip fracture are cared for by a multidisciplinary team providing comprehensive geriatric assessments. Most of these studies have been conducted in academic centres. We sought to determine if implementation of an orthogeriatric collaborative care model would improve key quality of care metrics in a community hospital setting. This retrospective pre- and postintervention single-site study was conducted in a community hospital in Ontario, Canada. We included consecutive patients aged 65 years or older who were admitted for a hip fracture between June 2015 and June 2017. In the intervention period, a new postoperative order set included a referral to a geriatrician for comprehensive geriatric assessment, with direct implementation of recommendations. Primary outcomes were the incidence of postoperative delirium and length of stay. Secondary outcomes included Health Quality Ontario’s quality standards for hip fracture. A total of 212 consecutive patients (95 in the preintervention group and 117 in the postintervention group) were included in the study. The incidence of postoperative delirium (26.3% v. 26.5%, p = 0.98) and length of stay (interquartile range 4–10 v. 5–10 d, p = 0.32) were similar in the preintervention and postintervention groups. There were improvements (p < 0.001) in the rates of asssessment of mental status, falls and bone health; identification of delirium prevention strategies; prescription of vitamin D or calcium or both; and recommendations for antiresorptive therapy. Despite systemic implementation of the orthogeriatric model, only 74.4% of patients in the postintervention group were seen by a geriatric medicine consultant. Although the implementation of an orthogeriatric collaborative care model for older adults with a hip fracture did not reduce the incidence of postoperative delirium or length of stay, there were improvements in the rates at which several other key quality standards for hip fracture care were met. Earlier proactive, comprehensive geriatric assessment in a community hospital setting will be the target for further quality improvement initiatives.