Clinical effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients : population-based longitudinal study
Hawley, Samuel (University of Oxford)
Javaid, M. Kassim (MRC Lifecourse Epidemiology Unit, University of Southampton)
Prieto-Alhambra, Daniel (Institut Hospital del Mar d'Investigacions Mèdiques)
Lippett, Janet (Royal Berkshire NHS Foundation Trust, Reading)
Sheard, Sally (University of Oxford)
Arden, N. K (MRC Lifecourse Epidemiology Unit, University of Southampton)
Cooper, Cyrus (MRC Lifecourse Epidemiology Unit, University of Southampton)
Judge, Andrew (MRC Lifecourse Epidemiology Unit, University of Southampton)
Universitat Autònoma de Barcelona

Data:	2016
Resum:	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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Epidemiology ; Hip fracture ; Fracture liaison service ; Orthogeriatrician ; Osteoporosis ; Older people
Publicat a:	Age and Ageing, Vol. 45 (january 2016) , p. 236-242, ISSN 1468-2834

DOI: 10.1093/ageing/afv204
PMID: 26802076

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