دورية أكاديمية
Integrated hip fracture care pathway (IHFCP): reducing complications and improving outcomes.
| العنوان: | Integrated hip fracture care pathway (IHFCP): reducing complications and improving outcomes. |
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| المؤلفون: | Heyzer L; Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore., Ramason R; Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore., De Castro Molina JA; Health Services and Outcomes Research, National Healthcare Group, Tan Tock Seng Hospital, Singapore., Lim Chan WW; Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore., Loong CY; Population Health Office, National Healthcare Group, Tan Tock Seng Hospital, Singapore., Kee Kwek EB; Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore. |
| المصدر: | Singapore medical journal [Singapore Med J] 2022 Aug; Vol. 63 (8), pp. 439-444. Date of Electronic Publication: 2021 Apr 19. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Wolters Kluwer - Medknow Country of Publication: India NLM ID: 0404516 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 0037-5675 (Print) Linking ISSN: 00375675 NLM ISO Abbreviation: Singapore Med J Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: July 2022- : [Mumbai] : Wolters Kluwer - Medknow Original Publication: Singapore, Singapore Medical Assn. |
| مواضيع طبية MeSH: | Critical Pathways* , Hip Fractures*/surgery, Humans ; Aged ; Aftercare ; Patient Discharge ; Treatment Outcome ; Length of Stay ; Retrospective Studies |
| مستخلص: | Introduction: Hip fractures in elderly people are increasing. A five-year Integrated Hip Fracture Care Pathway (IHFCP) was implemented at our hospital for seamlessly integrating care for these patients from admission to post discharge. We aimed to evaluate how IHFCP improved process and outcome measures in these patients. Methods: A study was conducted over a five-year period on patients with acute fragility hip fracture who were managed on IHFCP. The evaluation utilised a descriptive design, with outcomes analysed separately for each of the five years of the programme. First-year results were treated as baseline. Results: The main improvements in process and outcome measures over five years, when compared to baseline, were: (a) increase in surgeries performed within 48 hours of admission from 32.5% to 80.1%; (b) reduced non-operated patients from 19.6% to 11.9%; (c) reduced average length of stay at acute hospital among surgically (from 14.0 ± 12.3 days to 9.9 ± 1.0 days) and conservatively managed patients (from 19.1 ± 22.9 to 11.0 ± 2.5 days); (d) reduced 30-day readmission rate from 3.2% to 1.6%; and (e) improved Modified Functional Assessment Classification of VI to VII at six months from 48.0% to 78.2%. Conclusion: The IHFCP is a standardised care path that can reduce time to surgery, average length of stay and readmission rates. It is distinct from other orthogeriatric care models, with its ability to provide optimal care coordination, early transfer to community hospitals and post-discharge day rehabilitation services. Consequently, it helped to optimise patients' functional status and improved their overall outcome. Competing Interests: None |
| References: | Arch Orthop Trauma Surg. 2014 Mar;134(3):351-7. (PMID: 24297214) JAMA. 2004 Apr 14;291(14):1738-43. (PMID: 15082701) J Am Acad Orthop Surg. 2015 Feb;23(2):138-40. (PMID: 25624366) Osteoporos Int. 1992 Nov;2(6):285-9. (PMID: 1421796) J Orthop Surg (Hong Kong). 2018 May-Aug;26(2):2309499018783909. (PMID: 29954285) J Am Geriatr Soc. 2008 Oct;56(10):1831-8. (PMID: 19054201) Cochrane Database Syst Rev. 2016 Nov 30;11:CD001880. (PMID: 27898998) J Orthop Trauma. 2014 Mar;28(3):e49-55. (PMID: 23912859) Osteoporos Int. 2009 Oct;20(10):1633-50. (PMID: 19421703) Arch Phys Med Rehabil. 2017 May;98(5):981-988. (PMID: 28137475) Singapore Med J. 2017 Mar;58(3):139-144. (PMID: 27056208) Clin Orthop Relat Res. 1982 Jul;(167):131-8. (PMID: 7094454) Eur J Phys Rehabil Med. 2011 Jun;47(2):257-64. (PMID: 21597435) BMJ. 1993 Nov 13;307(6914):1248-50. (PMID: 8166806) Osteoporos Sarcopenia. 2018 Mar;4(1):16-21. (PMID: 30775536) Osteoporos Int. 1997;7(5):407-13. (PMID: 9425497) Am J Med. 1997 Aug 18;103(2A):12S-17S; discussion 17S-19S. (PMID: 9302893) Calcif Tissue Int. 2012 Jul;91(1):1-14. (PMID: 22476267) J Gen Intern Med. 2006 Mar;21(3):219-25. (PMID: 16390507) PLoS One. 2012;7(10):e46175. (PMID: 23056256) Geriatr Orthop Surg Rehabil. 2010 Sep;1(1):6-14. (PMID: 23569656) Osteoporos Int. 2004 Nov;15(11):897-902. (PMID: 15490120) |
| فهرسة مساهمة: | Keywords: Complications; hip fracture; orthogeriatric; outcomes |
| تواريخ الأحداث: | Date Created: 20210419 Date Completed: 20221020 Latest Revision: 20221205 |
| رمز التحديث: | 20221205 |
| مُعرف محوري في PubMed: | PMC9584078 |
| DOI: | 10.11622/smedj.2021041 |
| PMID: | 33866715 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 0037-5675 |
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| DOI: | 10.11622/smedj.2021041 |