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The effectiveness of a co-management care model on older hip fracture patients in China – A multicentre non-randomised controlled study
BACKGROUND: Clinical guidelines recommend orthogeriatric care to improve older hip fracture patients’ outcomes, but few studies have been conducted in China. This study evaluated the effects of an orthogeriatric co-management care model in six Chinese hospitals. METHODS: This non-randomised controll...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8814766/ https://www.ncbi.nlm.nih.gov/pubmed/35141666 http://dx.doi.org/10.1016/j.lanwpc.2021.100348 |
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author | Zhang, Jing Yang, Minghui Zhang, Xinyi He, Jiusheng Wen, Liangyuan Wang, Xianhai Shi, Zongxin Hu, Sanbao Sun, Fengpo Gong, Zishun Sun, Mingyao Li, Qiang Peng, Ke Ye, Pengpeng Ma, Ruofei Zhu, Shiwen Wu, Xinbao Webster, Ruth J Ivers, Rebecca Q Tian, Maoyi |
author_facet | Zhang, Jing Yang, Minghui Zhang, Xinyi He, Jiusheng Wen, Liangyuan Wang, Xianhai Shi, Zongxin Hu, Sanbao Sun, Fengpo Gong, Zishun Sun, Mingyao Li, Qiang Peng, Ke Ye, Pengpeng Ma, Ruofei Zhu, Shiwen Wu, Xinbao Webster, Ruth J Ivers, Rebecca Q Tian, Maoyi |
author_sort | Zhang, Jing |
collection | PubMed |
description | BACKGROUND: Clinical guidelines recommend orthogeriatric care to improve older hip fracture patients’ outcomes, but few studies have been conducted in China. This study evaluated the effects of an orthogeriatric co-management care model in six Chinese hospitals. METHODS: This non-randomised controlled study was designed as an exploratory trial and was conducted in 3 urban and 3 suburban hospitals. Eligible patients were aged ≥ 65 years with X-ray confirmed hip fracture and admitted to hospital within 21 days of injury. All patients received three times follow-ups within one year (1-month, 4-month and 12-month post admission). Co-management care was implemented in 1 urban hospital, while usual care continued in 5 urban and suburban hospitals. Patient demographics, pre-, peri- and post-operative information, complications and mortality were collected at baseline and follow-ups. The primary outcome was proportion of patients receiving surgery within 48 hours from ward arrival. Secondary outcomes included osteoporosis assessment, in-hospital rehabilitation, length of hospital stay, in-hospital mortality and one-year cumulative mortality. FINDINGS: There were 2,071 eligible patients enrolled (1,110 intervention, 961 control). Compared to usual care, a significantly higher proportion of intervention patients received surgery within 48 hours (75% vs 27%, p<0.0001), osteoporosis assessment (99.9% vs 60.6%, p<0.0001), rehabilitation (99.1% vs 3.9%, p<0.0001) and shorter length of hospital stay (6.1 days vs 12.0 days, p<0.0001). The intervention group saw a significant lower in-hospital mortality rate than the control group (adjusted relative risk 0.021, 95% CI 0.001 to 0.45, P=0.01). One-year cumulative mortality was also significantly reduced in the intervention group (hazard ratio 0.59, 95% CI 0.38 to 0.80, p=0.01). INTERPRETATION: Co-management care of older hip fracture patients resulted in better outcomes, including decreased time to surgery, improved clinical management, and reduced one-year mortality. A randomised controlled trial is needed to provide definitive evidence. FUNDING: The study is supported by Capital's Funds for Health Improvement and Research (2018-1-2071). |
format | Online Article Text |
id | pubmed-8814766 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-88147662022-02-08 The effectiveness of a co-management care model on older hip fracture patients in China – A multicentre non-randomised controlled study Zhang, Jing Yang, Minghui Zhang, Xinyi He, Jiusheng Wen, Liangyuan Wang, Xianhai Shi, Zongxin Hu, Sanbao Sun, Fengpo Gong, Zishun Sun, Mingyao Li, Qiang Peng, Ke Ye, Pengpeng Ma, Ruofei Zhu, Shiwen Wu, Xinbao Webster, Ruth J Ivers, Rebecca Q Tian, Maoyi Lancet Reg Health West Pac Articles BACKGROUND: Clinical guidelines recommend orthogeriatric care to improve older hip fracture patients’ outcomes, but few studies have been conducted in China. This study evaluated the effects of an orthogeriatric co-management care model in six Chinese hospitals. METHODS: This non-randomised controlled study was designed as an exploratory trial and was conducted in 3 urban and 3 suburban hospitals. Eligible patients were aged ≥ 65 years with X-ray confirmed hip fracture and admitted to hospital within 21 days of injury. All patients received three times follow-ups within one year (1-month, 4-month and 12-month post admission). Co-management care was implemented in 1 urban hospital, while usual care continued in 5 urban and suburban hospitals. Patient demographics, pre-, peri- and post-operative information, complications and mortality were collected at baseline and follow-ups. The primary outcome was proportion of patients receiving surgery within 48 hours from ward arrival. Secondary outcomes included osteoporosis assessment, in-hospital rehabilitation, length of hospital stay, in-hospital mortality and one-year cumulative mortality. FINDINGS: There were 2,071 eligible patients enrolled (1,110 intervention, 961 control). Compared to usual care, a significantly higher proportion of intervention patients received surgery within 48 hours (75% vs 27%, p<0.0001), osteoporosis assessment (99.9% vs 60.6%, p<0.0001), rehabilitation (99.1% vs 3.9%, p<0.0001) and shorter length of hospital stay (6.1 days vs 12.0 days, p<0.0001). The intervention group saw a significant lower in-hospital mortality rate than the control group (adjusted relative risk 0.021, 95% CI 0.001 to 0.45, P=0.01). One-year cumulative mortality was also significantly reduced in the intervention group (hazard ratio 0.59, 95% CI 0.38 to 0.80, p=0.01). INTERPRETATION: Co-management care of older hip fracture patients resulted in better outcomes, including decreased time to surgery, improved clinical management, and reduced one-year mortality. A randomised controlled trial is needed to provide definitive evidence. FUNDING: The study is supported by Capital's Funds for Health Improvement and Research (2018-1-2071). Elsevier 2021-12-31 /pmc/articles/PMC8814766/ /pubmed/35141666 http://dx.doi.org/10.1016/j.lanwpc.2021.100348 Text en © 2021 The Authors https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Articles Zhang, Jing Yang, Minghui Zhang, Xinyi He, Jiusheng Wen, Liangyuan Wang, Xianhai Shi, Zongxin Hu, Sanbao Sun, Fengpo Gong, Zishun Sun, Mingyao Li, Qiang Peng, Ke Ye, Pengpeng Ma, Ruofei Zhu, Shiwen Wu, Xinbao Webster, Ruth J Ivers, Rebecca Q Tian, Maoyi The effectiveness of a co-management care model on older hip fracture patients in China – A multicentre non-randomised controlled study |
title | The effectiveness of a co-management care model on older hip fracture patients in China – A multicentre non-randomised controlled study |
title_full | The effectiveness of a co-management care model on older hip fracture patients in China – A multicentre non-randomised controlled study |
title_fullStr | The effectiveness of a co-management care model on older hip fracture patients in China – A multicentre non-randomised controlled study |
title_full_unstemmed | The effectiveness of a co-management care model on older hip fracture patients in China – A multicentre non-randomised controlled study |
title_short | The effectiveness of a co-management care model on older hip fracture patients in China – A multicentre non-randomised controlled study |
title_sort | effectiveness of a co-management care model on older hip fracture patients in china – a multicentre non-randomised controlled study |
topic | Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8814766/ https://www.ncbi.nlm.nih.gov/pubmed/35141666 http://dx.doi.org/10.1016/j.lanwpc.2021.100348 |
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