ReviewIdentifying a standard set of outcome parameters for the evaluation of orthogeriatric co-management for hip fractures
Introduction
Osteoporotic fractures are an increasing problem in the world due to the ageing of the population. Older adults with osteoporotic fractures frequently have one or more co-morbidities, making the treatment of these patients complex. These fractures can lead to an increased risk of mortality, disability, complications and high health-care costs [1], [2], [3]. Due to the unsatisfactory treatment outcomes often seen in patients with osteoporotic fractures, multidisciplinary treatment approaches have been implemented to improve outcome [4].
A common multidisciplinary approach is a highly focussed team: orthopaedic surgeons, anaesthesiologists and geriatricians work together to reduce the number and severity of complications often seen in the usual treatment of patients with osteoporotic fractures. Other ‘team members’ such as physiotherapists, study nurses and nutritional care and physician assistants can contribute to the multidisciplinary treatment approach. Different models of orthogeriatric co-management are well described by Giusti et al. [5] and can be distinguished by the health-care professional who has the responsibility of care in the acute and early rehabilitation phases. These orthogeriatric models have been implemented in many institutions, have different key elements and use different outcome parameters [4], [6].
Some of the models have proven to be effective [7], but there is no consensus about the best possible treatment model. In order to compare the different models, it is important to agree on which outcome parameters should be measured and how they should be measured [6], [8].
Although no consensus about the goals of an orthogeriatric co-management exists yet in the literature, some primary targets have already been suggested [9], [10], [11]. The main goals of an orthogeriatric co-management are:
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return to pre-fracture status as soon as possible,
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improvement of patient and family satisfaction,
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reduce complication, re-admission and mortality rates,
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provide best value of care to the health system and
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initiate secondary fracture prevention.
Our goal was to propose a definition of a standard set of outcome parameters which could be used in evaluation and comparison research studies of different models of orthogeriatric co-management used in hip fracture treatment. We also wanted to define time points for the evaluation of these parameters. These outcome parameters should be relatively easy to assess and should be able to evaluate the degree of achievement of the main goals of an orthogeriatric co-management.
Section snippets
List of outcome parameters
In order to establish a list of outcome parameters that should be considered in the evaluation of orthogeriatric co-management, the existing literature was reviewed. The systematic review of Kammerlander et al. [4] was used to identify studies comparing standard care and orthogeriatric co-management. The most-used outcome parameters based on frequency from the different studies presented in the review paper were selected. The following outcomes were further analysed:
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mortality,
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length of stay,
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Mortality
Mortality is a common outcome parameter reported in the medical literature. It is known that mortality rates after osteoporotic fractures of the shoulder, hip and spine are increased in comparison to the age-matched population, but the reasons for this remains unclear [15], [16], [17], [18]. Mortality is clearly an important outcome parameter to be measured.
In-hospital mortality is frequently used as an outcome parameter, but it is difficult to use in an international comparison study because
Discussion
To evaluate the best possible treatment model in hip fracture management and allow for international comparison, a standard set of outcome parameters should be determined and defined. The authors were able to come to an agreement regarding which outcome parameters should be used in the evaluation and comparison of different orthogeriatric co-management models for the treatment of hip fractures. Further, the time points to record these outcome parameters are suggested as well as which score or
Conclusion
We have come to an agreement about the outcome parameters that we think should be used to evaluate and compare different orthogeriatric clinical care models in the treatment of hip fractures. The parameters to be collected include length of hospital stay, mortality, time to surgery, complications both medical and surgical, 30-day re-admission rate, mobility, quality of life, pain levels, adverse drug reactions, activities of daily living, place of residence and costs of care. The time points at
Role of the funding source
This project was sponsored by AO Trauma.
Conflict of interest
The authors declare that they have no conflict of interest.
Acknowledgements
We would like to M. Neuman for his ideas and comments to help improve this manuscript. We would also like to thank P. Büscher and AOTrauma for their support of this effort to improve hip fracture care.
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