Different approaches towards geriatric trauma care for hip fracture patients: an inter-hospital comparison

Kusen, Jip Q.; Vet, Puck van der; Wijdicks, Frans-Jasper; Houwert, Marijn; Dijkgraaf, Marcel G. W.; Hamaker, Marije E.; Geraghty, Olivia; Verleisdonk, Egbert-Jan M. M.; Velde, Detlef van der

doi:10.1007/s00068-019-01129-x

Cited by 8 publications

(5 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…30 Multidisciplinary care pathways like the one in this study have become increasingly popular over the past years and are effective in bettering (objective) outcomes. 34,35 Whilst such care pathways for hip fractures are well defined, it has been stated that fractures around the ankle are as devastating but largely overlooked, even though they are the third most common fracture location and with studies indicating a rising incidence and severity as well as worsening of functional outcome with age. [36][37][38][39] This study also found low QoL outcomes in ankle fracture patients and therefore, we encourage future studies to establish evidence-based treatment recommendations.…”

Section: Discussionmentioning

confidence: 99%

The Quality of Life, Patient Satisfaction and Rehabilitation in Patients With a Low Energy Fracture—Part III of an Observational Study

Vet

Kusen

Rohner-Spengler

et al. 2021

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

Introduction Due to the aging population the incidence of Low Energy Fractures (LEF) increases. LEF have high mortality and morbidity rates and often cause elderly to lose independence. Patient-reported outcomes, such as Quality of Life (QoL) and patient satisfaction (PS) are needed to evaluate treatment, estimate cost-benefit analyses, and to improve clinical decision-making and patient-centered care. Objective The primary goal was to evaluate QoL and PS in patients with LEF, and to compare QoL scores to the community dwelling population. Second, we observed the amount and type of physiotherapy (PT) sessions the patients conducted. Methods A single-center cohort study was conducted in Switzerland. Patients between 50 and 85 years, who were treated in the hospital for LEF, were followed 1 year after initial fracture. Data on QoL were obtained through the Euroqol-5-Dimension questionnaire-3-Level (EQ-5D-3L) and the EQ VAS (visual analog scale). PS was measured by a VAS on satisfaction with treatment outcome. Data on PT sessions, mobility and use of analgesics were collected by telephone interviews and written surveys. Results were compared between the different fracture locations and subgroup analyses were performed for age categories. Results 411 patients were included for analysis. The median scores of the EQ-5D-3L index—VAS and PS were 0.90 (0.75–1.0), 90 (71.3–95) and 100 (90–100). Significant differences in all scores were found between fracture location ( P < .05), with hip fracture patients and patients with a malleolar fracture scoring lowest in all measures. QoL index in hip fracture patients was 0.76 (0.70–1.00), QoL VAS 80 (70–90), and PS 95 (80–100). Median amount of PT sessions in all patients was 18 (9–27) and a significant difference was found between fracture locations. Patients with a fracture of the humerus received the highest amount of PT sessions 27 (18–36), hip fracture patients had a median of 18 (9–27) sessions. Conclusion At follow-up, QoL throughout all patients with a LEF was comparable to a normal population. Remarkably, though hip fracture patients seem to suffer from a clinically relevant loss of QoL, they received fewer PT sessions and performed fewer long-lasting home training than patients with a humerus fracture. Intensive, progressive rehabilitation with a high frequency of supervised training is recommended after hip fracture. The low frequency of PT sessions found in this study is unsatisfying. In hip fracture patients and in patients with a malleolar fracture, especially when aged over 75 years, more efforts are required to improve rehabilitation and subsequently QoL.

show abstract

Section: Discussionmentioning

confidence: 99%

The Quality of Life, Patient Satisfaction and Rehabilitation in Patients With a Low Energy Fracture—Part III of an Observational Study

Vet

Kusen

Rohner-Spengler

et al. 2021

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

show abstract

“…190 studies underwent full-text review, and 69 studies were selected for final analysis (Figure and eAppendix 3 in the Supplement). Among the final 69 improvement programs, 49 programs significantly decreased TTS and 20 programs did not. Delayed TTS cutoffs were most often defined dichotomously as more than 24 hours, more than 36 hours, more than 48 hours, or more than 72 hours, although some studies collected continuous data.…”

Section: Resultsmentioning

confidence: 90%

“…190 studies underwent full-text review, and 69 studies were selected for final analysis ( Figure and eAppendix 3 in the Supplement ). 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 …”

Section: Resultsmentioning

confidence: 99%

“…190 studies underwent full-text review, and 69 studies were selected for final analysis (Figure and eAppendix 3 in the Supplement). Among the final 69 improvement programs, 49 programs significantly decreased TTS 33,35,38,41,[43][44][45][46][47][48][49][51][52][53][54]56,57,[59][60][61][62][65][66][67][68][69][70][71][72][74][75][76][79][80][81][82][85][86][87][88]91,94,96,97,99,101,103 and 20 programs 39,40,42,50,…”

Section: Included Studiesmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

et al. 2022

View full text Add to dashboard Cite

IMPORTANCE Longer time to surgery (TTS) for hip fractures has been associated with higher rates of postoperative complications and mortality. Given that more than 300 000 adults are hospitalized for hip fractures in the United States each year, various improvement programs have been implemented to reduce TTS with variable results, attributed to contextual patient-and systemlevel factors. OBJECTIVETo catalog TTS improvement programs, identify their results, and categorize program strategies according to Expert Recommendations for Implementing Change (ERIC), highlighting components of successful improvement programs within their associated contexts and seeking to guide health care systems in implementing programs designed to reduce TTS. EVIDENCE REVIEW A systematic review was conducted per the Preferred Reporting Items forSystematic Reviews and Meta-analyses guideline. Three databases (MEDLINE/PubMed, EMBASE, and Cochrane Trials) were searched for studies published between 2000 and 2021 that reported on improvement programs for hip fracture TTS. Observational studies in high-income country settings, including patients with surgical, low-impact, nonpathological hip fractures aged 50 years or older, were considered for review. Improvement programs were assessed for their association with decreased TTS, and ERIC strategies were matched to improvement program components.FINDINGS Preliminary literature searches yielded 1683 articles, of which 69 articles were included for final analysis. Among the 69 improvement programs, 49 were associated with significantly decreased TTS, and 20 programs did not report significant decreases in TTS. Among 49 successful improvement programs, the 5 most common ERIC strategies were (1) assess for readiness and identify barriers and facilitators, (2) develop a formal implementation blueprint, (3) identify and prepare champions, (4) promote network weaving, and (5) develop resource-sharing agreements. CONCLUSIONS AND RELEVANCEIn this systematic review, certain components (eg, identifying barriers and facilitators to program implementation, developing a formal implementation blueprint, preparing intervention champions) are common among improvement programs that were associated with reducing TTS and may inform the approach of hospital systems developing similar programs. Other strategies had mixed results, suggesting local contextual factors (eg, operating room availability) may affect their success. To contextualize the success of a given improvement program across different clinical settings, subsequent investigation must elucidate the association between interventional success and facility-level factors influencing TTS, such as hospital census and type, teaching status, annual surgical volume, and other factors.

show abstract

“…Seven papers reported MoCs implemented at two hospitals, 26 32 42 61 65 66 97 and six papers reported multisite implementation or participation. 24 33 38 50 70 94 The remaining 69 papers reported single-site implementation.…”

Section: Resultsmentioning

confidence: 99%

Do we understand each other when we develop and implement hip fracture models of care? A systematic review with narrative synthesis

Armstrong,

Harvey,

Payne

et al. 2023

BMJ Open Qual

View full text Add to dashboard Cite

BackgroundA hip fracture in an older person is a devastating injury. It impacts functional mobility, independence and survival. Models of care may provide a means for delivering integrated hip fracture care in less well-resourced settings. The aim of this review was to determine the elements of hip fracture models of care to inform the development of an adaptable model of care for low and middle-income countries (LMICs).MethodsMultiple databases were searched for papers reporting a hip fracture model of care for any part of the patient pathway from injury to rehabilitation. Results were limited to publications from 2000. Titles, abstracts and full texts were screened based on eligibility criteria. Papers were evaluated with an equity lens against eight conceptual criteria adapted from an existing description of a model of care.Results82 papers were included, half of which were published since 2015. Only two papers were from middle-income countries and only two papers were evaluated as reporting all conceptual criteria from the existing description. The most identified criterion was an evidence-informed intervention and the least identified was the inclusion of patient stakeholders.ConclusionInterventions described as models of care for hip fracture are unlikely to include previously described conceptual criteria. They are most likely to be orthogeriatric approaches to service delivery, which is a barrier to their implementation in resource-limited settings. In LMICs, the provision of orthogeriatric competencies by other team members is an area for further investigation.

show abstract

Different approaches towards geriatric trauma care for hip fracture patients: an inter-hospital comparison

Cited by 8 publications

References 20 publications

The Quality of Life, Patient Satisfaction and Rehabilitation in Patients With a Low Energy Fracture—Part III of an Observational Study

The Quality of Life, Patient Satisfaction and Rehabilitation in Patients With a Low Energy Fracture—Part III of an Observational Study

Evaluation of Systemwide Improvement Programs to Optimize Time to Surgery for Patients With Hip Fractures

Do we understand each other when we develop and implement hip fracture models of care? A systematic review with narrative synthesis

Contact Info

Product

Resources

About