The development of a comprehensive multidisciplinary care pathway for patients with a hip fracture: design and results of a clinical trialReport as inadecuate




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BMC Musculoskeletal Disorders

, 15:188

Rehabilitation, physical therapy and occupational health

Abstract

BackgroundHip fractures frequently occur in older persons and severely decrease life expectancy and independence. Several care pathways have been developed to lower the risk of negative outcomes but most pathways are limited to only one aspect of care. The aim of this study was therefore to develop a comprehensive care pathway for older persons with a hip fracture and to conduct a preliminary analysis of its effect.

MethodsA comprehensive multidisciplinary care pathway for patients aged 60 years or older with a hip fracture was developed by a multidisciplinary team. The new care pathway was evaluated in a clinical trial with historical controls. The data of the intervention group were collected prospectively. The intervention group included all patients with a hip fracture who were admitted to University Medical Center Groningen between 1 July 2009 and 1 July 2011. The data of the control group were collected retrospectively. The control group comprised all patients with a hip fracture who were admitted between 1 January 2006 and 1 January 2008. The groups were compared with the independent sample t-test, the Mann–Whitney U-test or the Chi-squared test Phi test. The effect of the intervention on fasting time and length of stay was adjusted by linear regression analysis for differences between the intervention and control group.

ResultsThe intervention group included 256 persons women, 68%; mean age SD, 78 9 years and the control group 145 persons women, 72%; mean age SD, 80 10 years. Median preoperative fasting time and median length of hospital stay were significantly lower in the intervention group: 9 vs. 17 hours p < 0.001, and 7 vs. 11 days p < 0.001, respectively. A similar result was found after adjustment for age, gender, living condition and American Society of Anesthesiologists ASA classification. In-hospital mortality was also lower in the intervention group: 2% vs. 6% p < 0.05. There were no statistically significant differences in other outcome measures.

ConclusionsThe new comprehensive care pathway was associated with a significant decrease in preoperative fasting time and length of hospital stay.

KeywordsCare pathway Elderly Hip fracture Fasting time Length of stay Electronic supplementary materialThe online version of this article doi:10.1186-1471-2474-15-188 contains supplementary material, which is available to authorized users.

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Author: Elvira R Flikweert - Gerbrand J Izaks - Bas AS Knobben - Martin Stevens - Klaus Wendt

Source: https://link.springer.com/



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