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.	中华医学会骨科学分会骨质疏松学组. 骨质疏松性骨折诊疗指南. 中华骨科杂志, 2017, 37(1): 1-10.
4.	杨灵, 王志聪, 陈曦, 等. 891 例老年髋部骨折患者合并基础疾病的特点及 Charlson 合并症指数对预后的影响. 山东医药, 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.	杨明辉, 王颢, 李文菁, 等. 骨科和老年科共同管理模式治疗老年人髋部骨折的疗效分析. 中华老年医学杂志, 2018, 37(12): 1312-1315.
7.	童绪军, 金绍林, 丁文斌. 绿色通道 48 小时内手术治疗老年髋部骨折. 中国矫形外科杂志, 2021, 29(4): 373-374, 377.
8.	芮云峰, 邱晓东, 邹继红, 等. 多学科协作诊疗模式在老年髋部骨折的临床应用. 中国修复重建外科杂志, 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, 鲁攀攀, 等. 多学科协作诊疗模式在老年髋部骨折临床应用中的研究进展. 中国修复重建外科杂志, 2020, 34(1): 132-138.
12.	杨亚, 梁晨, 陈桢, 等. 国内外多学科诊疗模式研究进展分析. 中国卫生质量管理, 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.	凌涛, 李嘉琪, 计成, 等. 我国医疗联合体政策梳理及现状分析. 中国医院, 2020, 24(7): 29-32.
15.	秦悦, 卢建龙, 顾化民, 等. 多学科综合诊疗模式在专科医联体中的探索. 中国医院管理, 2019, 39(5): 34-36.
16.	张彩凤, 顾淑玮, 马强, 等. 基于 2013-2020 年文献计量分析国内医联体热点研究及发展前沿. 中国医院, 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. 中华医学会骨科学分会骨质疏松学组. 骨质疏松性骨折诊疗指南. 中华骨科杂志, 2017, 37(1): 1-10.
4. 杨灵, 王志聪, 陈曦, 等. 891 例老年髋部骨折患者合并基础疾病的特点及 Charlson 合并症指数对预后的影响. 山东医药, 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. 杨明辉, 王颢, 李文菁, 等. 骨科和老年科共同管理模式治疗老年人髋部骨折的疗效分析. 中华老年医学杂志, 2018, 37(12): 1312-1315.
7. 童绪军, 金绍林, 丁文斌. 绿色通道 48 小时内手术治疗老年髋部骨折. 中国矫形外科杂志, 2021, 29(4): 373-374, 377.
8. 芮云峰, 邱晓东, 邹继红, 等. 多学科协作诊疗模式在老年髋部骨折的临床应用. 中国修复重建外科杂志, 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, 鲁攀攀, 等. 多学科协作诊疗模式在老年髋部骨折临床应用中的研究进展. 中国修复重建外科杂志, 2020, 34(1): 132-138.
12. 杨亚, 梁晨, 陈桢, 等. 国内外多学科诊疗模式研究进展分析. 中国卫生质量管理, 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. 凌涛, 李嘉琪, 计成, 等. 我国医疗联合体政策梳理及现状分析. 中国医院, 2020, 24(7): 29-32.
15. 秦悦, 卢建龙, 顾化民, 等. 多学科综合诊疗模式在专科医联体中的探索. 中国医院管理, 2019, 39(5): 34-36.
16. 张彩凤, 顾淑玮, 马强, 等. 基于 2013-2020 年文献计量分析国内医联体热点研究及发展前沿. 中国医院, 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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