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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, Nigel 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

Fecha: 2016
Resumen: 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.
Derechos: 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. Creative Commons
Lengua: Anglès
Documento: article ; recerca ; publishedVersion
Materia: Epidemiology ; Hip fracture ; Fracture liaison service ; Orthogeriatrician ; Osteoporosis ; Older people
Publicado en: Age and Ageing, Vol. 45 (january 2016) , p. 236-242, ISSN 1468-2834

DOI: 10.1093/ageing/afv204
PMID: 26802076

7 p, 376.1 KB

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