The effectiveness of a co-management care model on older hip fracture patients in China – A multicentre non-randomised controlled study
Summary: 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-randomise...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-02-01
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| Series: | The Lancet Regional Health. Western Pacific |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666606521002571 |
| _version_ | 1819107390420680704 |
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| author | Jing Zhang Minghui Yang Xinyi Zhang Jiusheng He Liangyuan Wen Xianhai Wang Zongxin Shi Sanbao Hu Fengpo Sun Zishun Gong Mingyao Sun Qiang Li Ke Peng Pengpeng Ye Ruofei Ma Shiwen Zhu Xinbao Wu Ruth J Webster Rebecca Q Ivers Maoyi Tian |
| author_facet | Jing Zhang Minghui Yang Xinyi Zhang Jiusheng He Liangyuan Wen Xianhai Wang Zongxin Shi Sanbao Hu Fengpo Sun Zishun Gong Mingyao Sun Qiang Li Ke Peng Pengpeng Ye Ruofei Ma Shiwen Zhu Xinbao Wu Ruth J Webster Rebecca Q Ivers Maoyi Tian |
| author_sort | Jing Zhang |
| collection | DOAJ |
| description | Summary: 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). |
| first_indexed | 2024-12-22T02:53:17Z |
| format | Article |
| id | doaj.art-a09b2f1dba9f49ebbe95d6656e45173d |
| institution | Directory Open Access Journal |
| issn | 2666-6065 |
| language | English |
| last_indexed | 2024-12-22T02:53:17Z |
| publishDate | 2022-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Western Pacific |
| spelling | doaj.art-a09b2f1dba9f49ebbe95d6656e45173d2022-12-21T18:41:19ZengElsevierThe Lancet Regional Health. Western Pacific2666-60652022-02-0119100348The effectiveness of a co-management care model on older hip fracture patients in China – A multicentre non-randomised controlled studyJing Zhang0Minghui Yang1Xinyi Zhang2Jiusheng He3Liangyuan Wen4Xianhai Wang5Zongxin Shi6Sanbao Hu7Fengpo Sun8Zishun Gong9Mingyao Sun10Qiang Li11Ke Peng12Pengpeng Ye13Ruofei Ma14Shiwen Zhu15Xinbao Wu16Ruth J Webster17Rebecca Q Ivers18Maoyi Tian19School of Population Health, University of New South Wales, Sydney, New South Wales, AustraliaDepartment of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China; Corresponding author: Minghui Yang, Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, ChinaThe George Institute for Global Health at Peking University Health Science Centre, Beijing, ChinaDepartment of Orthopaedics, Beijing Shunyi District Hospital, Beijing, ChinaDepartment of Orthopedics, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R.ChinaDepartment of Orthopaedics, Beijing Changping District Hospital, Beijing, ChinaDepartment of Orthopaedics, Beijing Liangxiang Hospital, Beijing, ChinaDepartment of Orthopaedics, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaDepartment of Orthopedics, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, P.R.ChinaDepartment of Orthopaedics, Beijing Liangxiang Hospital, Beijing, ChinaDepartment of Orthopaedics, Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaThe George Institute for Global Health, University of New South Wales, Sydney, New South Wales, AustraliaNational Clinical Research Center for Cardiovascular Diseases, Shenzhen, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, ChinaThe George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, ChinaDepartment of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, ChinaDepartment of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, ChinaDepartment of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, ChinaThe George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, AustraliaSchool of Population Health, University of New South Wales, Sydney, New South Wales, Australia; The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, AustraliaThe George Institute for Global Health at Peking University Health Science Centre, Beijing, China; The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia; School of Public Health, Harbin Medical University, Harbin, ChinaSummary: 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).http://www.sciencedirect.com/science/article/pii/S2666606521002571Hip fractureCo-management careOrthogeriatric careOlder peopleChina |
| spellingShingle | Jing Zhang Minghui Yang Xinyi Zhang Jiusheng He Liangyuan Wen Xianhai Wang Zongxin Shi Sanbao Hu Fengpo Sun Zishun Gong Mingyao Sun Qiang Li Ke Peng Pengpeng Ye Ruofei Ma Shiwen Zhu Xinbao Wu Ruth J Webster Rebecca Q Ivers Maoyi Tian The effectiveness of a co-management care model on older hip fracture patients in China – A multicentre non-randomised controlled study The Lancet Regional Health. Western Pacific Hip fracture Co-management care Orthogeriatric care Older people China |
| 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 | Hip fracture Co-management care Orthogeriatric care Older people China |
| url | http://www.sciencedirect.com/science/article/pii/S2666606521002571 |
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