The effectiveness of a co-management care model on older hip fracture patients in China – A multicentre non-randomised controlled study

Abstract

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.

Bringing orthogeriatric care for elderly patients with hip fractures to Asia

“…compared the outcomes of 1110 patients in a single hospital which employed Orthogeriatric co-management for hip fracture patients, to 961 patients across five other hospitals who received the usual standard of care with internal physician or geriatric consultation on a non-scheduled, as-required, basis. 8 The authors found that an orthogeriatric model significantly increased the proportion of patients receiving operation within 48 hours from ED arrival (42·9% vs 23·3%, RR = 2·0) and decreased one-year mortality rates (7·3% vs 12·3%, HR = 0·59). In addition, the orthogeriatric model also improved access to osteoporosis treatment (99·9% vs 60·6%) and rehabilitation (99·1% vs 3·9%).…”

“…In addition, the orthogeriatric model also improved access to osteoporosis treatment (99·9% vs 60·6%) and rehabilitation (99·1% vs 3·9%). 8 …”

Orthogeriatric co-management care models: The need for integrated practice units

“…Doing so, however, will require a critical assessment of integrated models to measure cost-efficacy and outcomes across a broad array of patient-centered metrics. As Zhang and colleagues call for the “scale-up of the orthogeriatric co-management care model,” 1 we encourage the inclusion of IPU-based orthogeriatric care in subsequent prospective trials.…”

“…Zhang and colleagues 1 should be lauded for their implementation of an orthogeriatric co-management care model for older adult hip fracture patients, resulting in decreased time to surgery, improved clinical management, and reduced one-year mortality. While these findings explore integrated care delivery models and corroborate previous evidence, we write to call attention to the need to expand these patient touchpoints longitudinally through integrated practice units (IPUs).…”

“…Given that the authors suggest geriatric medicine is under-developed in China 1 and likely in many other parts of the world, effective orthogeriatric IPUs may drastically improve patient outcomes and reduce costs compared to fragmented care by optimizing resource deployment and better engaging patients post-operatively 5 ; insights into these systems of care may have benefits for patients beyond countries like the US and China. Healthcare providers are at a crossroads in which they have an opportunity to re-shape the delivery of geriatric care.…”