• 作者：Juan Ignacio Gonzá ; lez Montalvo^a ; ^{jgonzalezm.hulp@salud.madrid.org} ; Pilar Gotor Pé ; rez^a ; Alberto Martí ; n Vega^b ; Teresa Alarcó ; n Alarcó ; n^a ; José ; Luis Mauleó ; n Á ; lvarez de Linera^c ; Enrique Gil Garay^c ; Eduardo Garcí ; a Cimbrelo^d ; Juliá ; n Alonso Biarge^d
• 关键词：Fractura de cadera ; Asistencia hospitalaria ; Aná ; lisis de costes
• 刊名：Revista Espa帽ola de Geriatr铆a y Gerontolog铆a
• 出版年：2011
• 期刊代码：pca313_0211139X
• 类别：med
• 出版时间：July-August 2011
• 卷：46
• 期：4
• 页码：193-199
• 文件大小：152 K

Objective

To study the effects of the management of hip fracture patients in an acute orthogeriatric unit shared between the departments of Orthopedic Surgery and Geriatrics compared with the usual hospital care, and to analyse financial differences in both systems of care.

Method

Prospective quasy-experimental randomized intervention study in 506 patients admited to a terciary hospital with an osteoporotic hip fracture. The usual model of care was the admission to the orthopedic ward with a request to Geriatrics (RC) and the study model consisted of the admission to an orthogeriatric unit (OGU) for the shared co-management between orthopaedic surgeons and geriatricians. This model included the appointment of one spokesperson from each department, the specialist geriatric nurse management, early geriatric assessment, shared daily clinical care, weekly joint ward round and coordinated planning of the surgery schedule, the start of the ambulation and the time and setting of patient discharge.

Results

Two hundred fifty five consecutive patients admitted to the OGU and 251 patients managed simultaneusly by the RC model were included. Except for a mean age slightly lower in the OGU group, there were no differences neither in the baseline patients characteristics nor in the surgical rates between the two groups. Among the OGU patients group it was more frequent to receive rehabilitation in the acute setting, to be able to walk at discharge and to be referred to a geriatric rehabilitation unit (all with P<.05). The OGU patients received geriatric assessment and were operated on earlier than the RC patients (P<.001). The length of stay in the acute ward was 34%shorter in the OGU patients (mean 12.48卤5 vs 18.9卤8.6 days, P<.001) (median 12 [9-14] vs 17 [13-23] days, P<.001). The whole hospital length of stay, including the days spent in the geriatric rehabilitation units, was 11%shorter in the OGU patients (mean 21.16 卤14.7 vs 23.9 卤13.8 days, P<0.05) (median 14 [10-31] vs 20 [14-30] days, P<.001). The OGU saved 1,207 鈧?to 1,633 鈧?per patient when estimated by the costs for process model, and 3,741 鈧?when estimated by the costs for stay model.

Conclusions

The OGU is a hospital setting that provides an improvement in the patients functional outcome and a reduction in the hospital length of stay. Therefore it saves health care resources. These findings show the OGU as an advisable setting for the acute care of hip fracture patients.