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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
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).
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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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