Clinical effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: population-based longitudinal study.
Age Ageing
; 45(2): 236-42, 2016 Mar.
Article
em En
| MEDLINE
| ID: mdl-26802076
ABSTRACT
OBJECTIVES:
to evaluate orthogeriatric and nurse-led fracture liaison service (FLS) models of post-hip fracture care in terms of impact on mortality (30 days and 1 year) and second hip fracture (2 years).SETTING:
Hospital Episode Statistics database linked to Office for National Statistics mortality records for 11 acute hospitals in a region of England. POPULATION patients aged over 60 years admitted for a primary hip fracture from 2003 to 2013.METHODS:
each hospital was analysed separately and acted as its own control in a before-after time-series design in which the appointment of an orthogeriatrician or set-up/expansion of an FLS was evaluated. Multivariable Cox regression (mortality) and competing risk survival models (second hip fracture) were used. Fixed effects meta-analysis was used to pool estimates of impact for interventions of the same type.RESULTS:
of 33,152 primary hip fracture patients, 1,288 sustained a second hip fracture within 2 years (age and sex standardised proportion of 4.2%). 3,033 primary hip fracture patients died within 30 days and 9,662 died within 1 year (age and sex standardised proportion of 9.5% and 29.8%, respectively). The estimated impact of introducing an orthogeriatrician on 30-day and 1-year mortality was hazard ratio (HR) = 0.73 (95% CI 0.65-0.82) and HR = 0.81 (CI 0.75-0.87), respectively. Following an FLS, these associations were as follows HR = 0.80 (95% CI 0.71-0.91) and HR = 0.84 (0.77-0.93). There was no significant impact on time to second hip fracture.CONCLUSIONS:
the introduction and/or expansion of orthogeriatric and FLS models of post-hip fracture care has a beneficial effect on subsequent mortality. No evidence for a reduction in second hip fracture rate was found.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ortopedia
/
Avaliação de Processos em Cuidados de Saúde
/
Prestação Integrada de Cuidados de Saúde
/
Geriatria
/
Serviços de Saúde para Idosos
/
Fraturas do Quadril
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Evaluation_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Systematic_reviews
Limite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Age Ageing
Ano de publicação:
2016
Tipo de documento:
Article
País de afiliação:
Reino Unido