The orthogeriatric comanagement improves clinical outcomes of hip fracture in older adults.

Treatment of older adults with hip fracture is a healthcare challenge. Orthogeriatric comanagement that is an integrated model of care with shared responsibility improves time to surgery and reduces the length of hospital stay and mortality compared with orthopedic care with geriatric consultation service and usual orthopedic care, respectively. INTRODUCTION: Treatment of fractures in older adults is a clinical challenge due partly to the presence of comorbidity and polypharmacy. The goal of orthogeriatric models of care is to improve clinical outcomes among older people with hip fractures. We compare clinical outcomes of persons with hip fracture cared according to orthogeriatric comanagement (OGC), orthopedic team with the support of a geriatric consultant service (GCS), and usual orthopedic care (UOC). METHODS: This is a single-center, pre-post intervention observational study with two parallel arms, OGC and GCS, and a retrospective control arm. Hip fracture patients admitted to the trauma ward were assigned by the orthopedic surgeon to the OGC (n = 112) or GCS (n = 108) group. The intervention groups were compared each with others and both with the retrospective control group (n = 210) of older adults with hip fracture. Several clinical indicators are considered, including time to surgery, length of stay, in-hospital, and 1-year mortality. RESULTS: Patients in the OGC (OR 2.62; CI 95% 1.40-4.91) but not those in the GCS (OR 0.74; CI 95% 0.38-1.47) showed a higher probability of undergoing surgery within 48 h compared with those in the UOC. Moreover, the OGC (ß, - 1.08; SE, 0.54, p = 0.045) but not the GCS (ß, - 0.79; SE, 0.53, p = 0.148) was inversely associated with LOS. Ultimately, patients in the OGC (OR 0.31; CI 95 % 0.10-0.96) but not those in the GCS (OR 0.37; CI 95% 0.10-1.38) experienced a significantly lower 1-year mortality rate compared with those in the UOC. All analyses were independent of several confounders. CONCLUSIONS: Older adults with hip fracture taken in care by the OGC showed better clinical indicators, including time to surgery, length of stay and mortality, than those managed by geriatric consultant service or usual orthopedic care.

Patient mobility for bone marrow transplant: the experience of the Perugia Hospital, years 2000-2013.

INTRODUCTION: Patient mobility, driven by patient preference is an indirect indicator of perception of hospital quality. Patients' choices depend on their previous healthcare experiences, the reputation of the hospital staff and the network of relationships between the patient, hospital doctors, general practitioners/reference specialists, etc. Therefore, the analysis of patient preferences provides an idea of hospital quality as well as qualitative and quantitative lack of services. The aim of the present research was to describe and analyze patient mobility for bone marrow transplantation regarding the Hospital of Perugia, which represents the second most important structure for bone marrow transplant in Italy. METHODS: Data have been collected from hospital discharge records in the ordinary regime related to the Diagnosis Related Group 481 "bone marrow transplant" since 2000 to 2013. We included autologous and allogenic transplant, in the adult and the child. Analysis of escaped, attracted and resident patients flows was undertaken using Gandy's nomogram which detects, through repeated time investigations, patients' movement inside and outside their catchment area. RESULTS: Between 2000 and 2013, 1782 patients were admitted to hospital with a DRG 481 "bone marrow transplant". Nine hundred and nineteen (51,5%) were resident in Umbria region, 799 (44,8%) in other regions, 64 (0,3%) abroad. Escapes were 158. The high percentage of admissions represented by patients that live out of Umbria, shows a high attractive power of the hospital. For "distant regions" this situation was maintained from 2000 to 2003, with a mild decrease from 2004 and, from 2010, the situation is stable. Only for "bordering regions" the attraction, which was stable up to 2010, seems to decrease. Gandy's nomogram shows also that the hospital was able to satisfy the health needs of the Umbria residents between 2004 and 2009 with a reductions in the escapes; then, in the last four years there is an increase in Umbria residents who seek care outside the catchment area and, in the last two years a reduction in the attraction power also. CONCLUSIONS: During the analyzed period of time, the Hospital of Perugia has been a choice for patients needing a bone marrow transplant. In the last period of the analysis it seems that patients preferences have changed. The increased availability of new hematologic centers explains two phenomena: on the one hand patients tend to not move for the examined DRG, so that there is a reduction in incoming patients from bordering regions; on the other hand the competition to attract patients from the catchment area leads to an increase in the quality of the service.

Incidence, mortality and long-term survival from prostate cancer in Umbria, Italy, 1978-1994.

OBJECTIVES AND METHODS: Incidence, mortality and long-term survival from prostate cancer were examined in the Umbria region of Italy, for the period 1978-1994. Incidence rates were derived from an ad hoc survey carried out over the period 1978-1982 and from 1994 cancer registry records. The mortality over the period derived from data of the official publications and the survival rates, at 15 years, were calculated starting from the ad hoc survey incident cases. RESULTS: In the Umbria region, over the period 1978-1994, crude incidence rates from prostate cancer increased from 31.2 to 81. 9 per 100,000 and mortality rates from 22.7 to 31.9 per 100,000. The rates were from 30.5 to 61.2 for age-adjusted incidence while standardized mortality remained constant (from 22.6 to 22.7 per 100, 000). Survival in Umbria, compared with rates from other European Cancer Registries, is low both at 5- and 10-year follow-up. CONCLUSION: The great incidence increase observed over the study period could depend on a lesser completeness achieved by the 1978-1982 ad hoc survey with respect to the 1994 cancer registry data and/or from the screening campaign carried out in a large part of the region in 1994. Different elements support these hypotheses. However the above hypotheses can be verified over the next years when further incidence and survival data from the cancer registry will be available.

Long term survival of upper aerodigestive tract cancer in male patients in the Umbria region (Italy).

The aim of this work was to make a study of the whole population of a central Italian region, the Umbria region--cancer survival rates for the upper aerodigestive tract, which includes cancers of the head and neck (tongue, oral cavity, pharynx), oesophagus and larynx. In Italy cancer survival rates do not cover entire regions but single municipalities or provinces. Cases of incidence were derived from an 'ad hoc' survey carried out during the period 1978-1982. Starting from the nominative data, we studied up to 15 years 245 head and neck, 87 oesophagus and 321 larynx cases of cancer in males. Data for female cases were not considered because of the small number. Cancer cases were followed up mainly by verification at the Registry Office of several municipalities, the Regional Death Registry and the list of persons under the Regional Health Service. Observed survival rates for head and neck cancer were 0.63, 0.29, 0.17 and 0.12 at 1, 5, 10 and 15 years of follow-up respectively; rates for cancers of the oesophagus and larynx were 0.30, 0.08, 0.06, 0.03 and 0.79, 0.54, 0.41, 0.30 respectively. Relative survival rates were 0.65, 0.34, 0.24, 0.23 for cancer of the head and neck, 0.31, 0.10, 0.09, 0.08 for cancer of the oesophagus, and 0.81, 0.63, 0.59, 0.56 for cancer of the larynx, at 1, 5, 10 and 15 years of follow-up. The worst survival rates were observed for oesophagus and hypopharynx. Overall survival values for Umbrian patients were relatively good, being higher than survival data reported for a similar period by Italian Cancer Registries. They were also strikingly similar to survival rates for England and Scotland.