Clinical application of multidisciplinary team in elderly patients with hip fracture under the model of close-type medical alliance_West China Medical Journal

Authors：

JIANG Wei , WANG Zhicong ,  CHEN Xi , GAO Bo , YANG Ling , WANG Hong , LIU Yuehong

Department of Orthopedics, Deyang People’s Hospital / Orthopedic Center of Deyang City, Deyang, Sichuan 618000, P. R. China;

Corresponding?author：

CHEN Xi, Email: chenxidoctor@163.com

Keywords：

Multidisciplinary team; hip fracture; medical alliance; elderly

DOI：

10.7507/1002-0179.202207088

Video：

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Objective To explore the clinical effect of multidisciplinary team (MDT) in elderly patients with hip fracture under the model of close-type medical alliance. Methods The elderly patients with hip fracture treated in the Department of Orthopedics of Deyang People’s Hospital between January 2015 and December 2020 were included retrospectively. According to different treatment modes, the patients were divided into traditional mode treatment group (traditional group) and MDT mode treatment group (MDT group). The waiting time for operation, hospitalization time after operation, total hospitalization time, total hospitalization cost, and death and loss of follow-up were analyzed. Results A total of 661 patients were enrolled, including 275 in the traditional group and 386 in the MDT group. There was no significant difference between the two groups in terms of gender, age, Charlson comorbidity index, types of fracture or surgical methods (P>0.05). The waiting time for operation [5.50 (3.50, 7.50) vs. 6.00 (4.00, 6.00) d; Z=?3.473, P=0.001], hospitalization time after operation [7.44 (6.27, 8.67) vs. 8.34 (6.72, 13.70) d; Z=?4.996, P<0.001] and total hospitalization time [12.95 (10.46, 16.30) vs. 15.49 (11.77, 19.91) d; Z=?5.718, P<0.001] in the MDT group were shorter than those in the traditional group. The total hospitalization cost of the MDT group was higher than that of the traditional group, but the difference was not statistically significant [39 300 (33 400, 46 400) vs. 38 000 (31 800, 44 000) Yuan; Z=1.524, P=0.128]. There was no significant difference in the lost follow-up rate between the traditional group and the MDT group (9.82% vs. 6.48%; χ²=2.474, P=0.116). Except in-hospital mortality and 30-day postoperative mortality (P>0.05), there was significant difference between the traditional group and the MDT group in 6-month (6.45% vs. 2.77%; χ²=4.875, P=0.027) and 1-year (11.29% vs. 6.37%; χ²=4.636, P=0.031) postoperative mortality. Conclusion Under the model of close-type medical alliance, MDT can reduce the waiting time for operation, hospitalization time after operation, total hospitalization time, as well as 6-month and 1-year postoperative mortality.

Citation： JIANG Wei, WANG Zhicong, CHEN Xi, GAO Bo, YANG Ling, WANG Hong, LIU Yuehong. Clinical application of multidisciplinary team in elderly patients with hip fracture under the model of close-type medical alliance. West China Medical Journal, 2022, 37(10): 1507-1511. doi: 10.7507/1002-0179.202207088 Copy

1.	Gong XF, Li XP, Zhang LX, et al. Current status and distribution of hip fractures among older adults in China. Osteoporos Int, 2021, 32(9): 1785-1793.
2.	Hou XL, Liu JY, Fan XH, et al. Secular trends of incidence and hospitalization cost of hip fracture in Tangshan, China. Osteoporos Int, 2022, 33(1): 89-96.
3.	中華醫學會骨科學分會骨質疏松學組. 骨質疏松性骨折診療指南. 中華骨科雜志, 2017, 37(1): 1-10.
4.	楊靈, 王志聰, 陳曦, 等. 891 例老年髖部骨折患者合并基礎疾病的特點及 Charlson 合并癥指數對預后的影響. 山東醫藥, 2022, 62(2): 67-70.
5.	Wang Y, Cui H, Zhang D, et al. Hospitalisation cost analysis on hip fracture in China: a multicentre study among 73 tertiary hospitals. BMJ Open, 2018, 8(4): e019147.
6.	楊明輝, 王顥, 李文菁, 等. 骨科和老年科共同管理模式治療老年人髖部骨折的療效分析. 中華老年醫學雜志, 2018, 37(12): 1312-1315.
7.	童緒軍, 金紹林, 丁文斌. 綠色通道 48 小時內手術治療老年髖部骨折. 中國矯形外科雜志, 2021, 29(4): 373-374, 377.
8.	芮云峰, 邱曉東, 鄒繼紅, 等. 多學科協作診療模式在老年髖部骨折的臨床應用. 中國修復重建外科雜志, 2019, 33(10): 1276-1282.
9.	Wang ZC, Jiang W, Chen X, et al. Systemic immune-inflammation index independently predicts poor survival of older adults with hip fracture: a prospective cohort study. BMC Geriatr, 2021, 21(1): 155.
10.	Griffiths R, Babu S, Dixon P, et al. Guideline for the management of hip fractures 2020: guideline by the association of anaesthetists. Anaesthesia, 2021, 76(2): 225-237.
11.	周洋洋, 芮云峰, 魯攀攀, 等. 多學科協作診療模式在老年髖部骨折臨床應用中的研究進展. 中國修復重建外科雜志, 2020, 34(1): 132-138.
12.	楊亞, 梁晨, 陳楨, 等. 國內外多學科診療模式研究進展分析. 中國衛生質量管理, 2021, 28(2): 16-19.
13.	Peng K, Liu H, Zhang J, et al. Applying normalization process theory and process mapping to understand implementation of a co-management program for older hip fracture patients in China: a qualitative study. Arch Osteoporos, 2020, 15(1): 92.
14.	凌濤, 李嘉琪, 計成, 等. 我國醫療聯合體政策梳理及現狀分析. 中國醫院, 2020, 24(7): 29-32.
15.	秦悅, 盧建龍, 顧化民, 等. 多學科綜合診療模式在專科醫聯體中的探索. 中國醫院管理, 2019, 39(5): 34-36.
16.	張彩鳳, 顧淑瑋, 馬強, 等. 基于 2013-2020 年文獻計量分析國內醫聯體熱點研究及發展前沿. 中國醫院, 2021, 25(4): 6-10.
17.	Shigemoto K, Sawaguchi T, Horii T, et al. Multidisciplinary care model for geriatric patients with hip fracture in Japan: 5-year experience. Arch Orthop Trauma Surg, 2022, 142(9): 2205-2214.
18.	Patel JN, Klein DS, Sreekumar S, et al. Outcomes in multidisciplinary team-based approach in geriatric hip fracture care: a systematic review. J Am Acad Orthop Surg, 2020, 28(3): 128-133.

1. Gong XF, Li XP, Zhang LX, et al. Current status and distribution of hip fractures among older adults in China. Osteoporos Int, 2021, 32(9): 1785-1793.
2. Hou XL, Liu JY, Fan XH, et al. Secular trends of incidence and hospitalization cost of hip fracture in Tangshan, China. Osteoporos Int, 2022, 33(1): 89-96.
3. 中華醫學會骨科學分會骨質疏松學組. 骨質疏松性骨折診療指南. 中華骨科雜志, 2017, 37(1): 1-10.
4. 楊靈, 王志聰, 陳曦, 等. 891 例老年髖部骨折患者合并基礎疾病的特點及 Charlson 合并癥指數對預后的影響. 山東醫藥, 2022, 62(2): 67-70.
5. Wang Y, Cui H, Zhang D, et al. Hospitalisation cost analysis on hip fracture in China: a multicentre study among 73 tertiary hospitals. BMJ Open, 2018, 8(4): e019147.
6. 楊明輝, 王顥, 李文菁, 等. 骨科和老年科共同管理模式治療老年人髖部骨折的療效分析. 中華老年醫學雜志, 2018, 37(12): 1312-1315.
7. 童緒軍, 金紹林, 丁文斌. 綠色通道 48 小時內手術治療老年髖部骨折. 中國矯形外科雜志, 2021, 29(4): 373-374, 377.
8. 芮云峰, 邱曉東, 鄒繼紅, 等. 多學科協作診療模式在老年髖部骨折的臨床應用. 中國修復重建外科雜志, 2019, 33(10): 1276-1282.
9. Wang ZC, Jiang W, Chen X, et al. Systemic immune-inflammation index independently predicts poor survival of older adults with hip fracture: a prospective cohort study. BMC Geriatr, 2021, 21(1): 155.
10. Griffiths R, Babu S, Dixon P, et al. Guideline for the management of hip fractures 2020: guideline by the association of anaesthetists. Anaesthesia, 2021, 76(2): 225-237.
11. 周洋洋, 芮云峰, 魯攀攀, 等. 多學科協作診療模式在老年髖部骨折臨床應用中的研究進展. 中國修復重建外科雜志, 2020, 34(1): 132-138.
12. 楊亞, 梁晨, 陳楨, 等. 國內外多學科診療模式研究進展分析. 中國衛生質量管理, 2021, 28(2): 16-19.
13. Peng K, Liu H, Zhang J, et al. Applying normalization process theory and process mapping to understand implementation of a co-management program for older hip fracture patients in China: a qualitative study. Arch Osteoporos, 2020, 15(1): 92.
14. 凌濤, 李嘉琪, 計成, 等. 我國醫療聯合體政策梳理及現狀分析. 中國醫院, 2020, 24(7): 29-32.
15. 秦悅, 盧建龍, 顧化民, 等. 多學科綜合診療模式在專科醫聯體中的探索. 中國醫院管理, 2019, 39(5): 34-36.
16. 張彩鳳, 顧淑瑋, 馬強, 等. 基于 2013-2020 年文獻計量分析國內醫聯體熱點研究及發展前沿. 中國醫院, 2021, 25(4): 6-10.
17. Shigemoto K, Sawaguchi T, Horii T, et al. Multidisciplinary care model for geriatric patients with hip fracture in Japan: 5-year experience. Arch Orthop Trauma Surg, 2022, 142(9): 2205-2214.
18. Patel JN, Klein DS, Sreekumar S, et al. Outcomes in multidisciplinary team-based approach in geriatric hip fracture care: a systematic review. J Am Acad Orthop Surg, 2020, 28(3): 128-133.

West China Medical Journal

Clinical application of multidisciplinary team in elderly patients with hip fracture under the model of close-type medical alliance

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