Clinical effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: population-based longitudinal study

S. Hawley, M.K. Javaid, D. Prieto-Alhambra, J. Lippett, S. Sheard, N.K. Arden, C. Cooper, A. Judge

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Abstract

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).Hospital Episode Statistics database linked to Office for National Statistics mortality records for 11 acute hospitals in a region of England.patients aged over 60 years admitted for a primary hip fracture from 2003 to 2013.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.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.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.
Original languageEnglish
Article numberafv024
Pages (from-to)236-242
Number of pages7
JournalAge and Ageing
Volume45
Issue number2
Early online date21 Jan 2016
DOIs
Publication statusPublished - Mar 2016

Keywords

  • REFReSH study group
  • Humans
  • Hip Fractures
  • Recurrence
  • Treatment Outcome
  • Hospitalization
  • Multivariate Analysis
  • Proportional Hazards Models
  • Risk Factors
  • Longitudinal Studies
  • Program Evaluation
  • Geriatrics
  • Orthopedics
  • Time Factors
  • Aged
  • Aged, 80 and over
  • Middle Aged
  • Health Services for the Aged
  • Health Services Research
  • Delivery of Health Care, Integrated
  • Patient Care Team
  • Process Assessment (Health Care)
  • Female
  • Male

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