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The effect of a multidisciplinary co-management program for the older hip fracture patients in Beijing: a “pre- and post-” retrospective study

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Abstract

Summary

Hip fracture becomes a major public health issue with the growing aging population. This study evaluated a multidisciplinary co-management program for older hip fracture patients and found it significantly improved the best practice indicators. It provided preliminary evidence to support the use of such intervention in hip fracture management.

Purpose/introduction

Hip fracture leads to high morbidity and mortality in older people. A previous study found a significant disparity in hip fracture management in Beijing Jishuitan Hospital (JSTH) compared to best practice care in the United Kingdom (UK). Following this audit, JSTH launched a multidisciplinary co-management care plan for older hip fracture patients. This study aims to evaluate the effect of this program on the six standards recommended in the UK hip fracture best practice guidelines.

Methods

In this retrospective study, electronic medical record data were collected before and after the intervention. Eligible patients were aged ≥ 65 years, had X-ray confirmed hip fracture, and were admitted to JSTH within 30 days of injury. Patient demographic information, time from emergency department presentation to admission, time from admission to surgery, pressure ulcers, osteoporosis assessment, and falls prevention were collected. Multivariable logistic and median regression models were used for binary and continuous outcomes respectively. Segment regression was also performed for time-related outcomes.

Results

A total of 3540 eligible patients were identified. After the intervention, half of the patients who received co-management received surgery within 48 h of ward admission compared to 6.4% previously, 0.3% (vs 1.4%) developed pressure ulcers, and 76% (vs 19%) received osteoporosis assessment. No significant differences were observed in fall assessment rates. However, there was a higher rate of ward admission within 4 h of arrival in emergency for patients admitted pre-intervention (61% vs 34%).

Conclusions

The introduction of the co-management model significantly reduced the time from admission to surgery and improved other practice outcomes. A multicenter randomized controlled trial is needed to evaluate the impact of this model on patient health outcomes.

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Funding

The study was funded by the Key Medical Professional Development Plans of Beijing Municipal Administration of Hospitals (ZYLX201506). Professor Rebecca Ivers is funded by a Research Fellowship from the National Health and Medical Research Council of Australia.

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Authors and Affiliations

  1. Department of Orthopaedic and Traumatology, Beijing Jishuitan Hospital, Beijing, China

    Xinbao Wu, Minghui Yang, Xiaofeng Gong, Manyi Wang & Wei Tian

  2. The George Institute for Global Health, Peking University Health Science Center, Beijing, China

    Maoyi Tian, Jing Zhang, Yishu Liu, Xian Li & Jiachao Ji

  3. The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia

    Maoyi Tian, Yishu Liu, Xian Li, Melanie Anderson, Ke Peng, Jagnoor Jagnoor & Rebecca Ivers

  4. Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

    Richard I. Lindley & Ke Peng

  5. School of Public Health and Community Medicine, University of New South Wales, Sydney, Kensington, NSW, 2052, Australia

    Melanie Anderson & Rebecca Ivers

Authors
  1. Xinbao Wu
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  2. Maoyi Tian
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  3. Jing Zhang
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  4. Minghui Yang
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  5. Xiaofeng Gong
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  6. Yishu Liu
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  7. Xian Li
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  8. Richard I. Lindley
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  9. Melanie Anderson
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  10. Ke Peng
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  11. Jagnoor Jagnoor
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  12. Jiachao Ji
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  13. Manyi Wang
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  14. Rebecca Ivers
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  15. Wei Tian
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Contributions

MY, MT, XW, and RI conceptualized the study. MY, MT, JZ, XG, RIL, JJ, XW, WT, and RI participated in the design of the study. JZ and YL coordinated and facilitated the data collection. JCJ and XL drafted the statistical analysis protocol and analyzed the data. MT and JZ drafted the manuscript. MY, MT, XW, MA, and RI participated in the critical review of the manuscript. All authors read and approved the final transcript.

Corresponding authors

Correspondence to Rebecca Ivers or Wei Tian.

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Xinbao Wu, Maoyi Tian, Jing Zhang, and Minghui Yang are equal first authors

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Wu, X., Tian, M., Zhang, J. et al. The effect of a multidisciplinary co-management program for the older hip fracture patients in Beijing: a “pre- and post-” retrospective study. Arch Osteoporos 14, 43 (2019). https://doi.org/10.1007/s11657-019-0594-1

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