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

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  • dc.contributor.author Hawley, Samuelca
  • dc.contributor.author Javaid, M. Kassimca
  • dc.contributor.author Prieto-Alhambra, Danielca
  • dc.contributor.author Lippett, Janetca
  • dc.contributor.author Sheard, Sallyca
  • dc.contributor.author Arden, Nigelca
  • dc.contributor.author Cooper, Cyrusca
  • dc.contributor.author Judge, Andrewca
  • dc.contributor.author The REFReSH Study Groupca
  • dc.date.accessioned 2016-04-13T10:53:47Z
  • dc.date.available 2016-04-13T10:53:47Z
  • dc.date.issued 2016
  • dc.description.abstract OBJECTIVES: 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). SETTING: Hospital Episode Statistics database linked to Office for National Statistics mortality records for 11 acute hospitals in a region of England. POPULATION: patients aged over 60 years admitted for a primary hip fracture from 2003 to 2013. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.ca
  • dc.description.sponsorship This work was supported by the National Institutes of Health and Research (NIHR) Health Services and Delivery Research programme (HS&DR) (project number 11/1023/01); and from the Oxford NIHR Musculoskeletal Biomedical Research Unit and Nuffield Orthopaedic Centre, University of Oxford.
  • dc.format.mimetype application/pdfca
  • dc.identifier.citation Hawley S, Javaid MK, Prieto-Alhambra D3, Lippett J, Sheard S, Arden NK. et al. Clinical effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: population-based longitudinal study. Age Ageing. 2016 Mar;45(2):236-42. doi: 10.1093/ageing/afv204.ca
  • dc.identifier.doi http://dx.doi.org/10.1093/ageing/afv204
  • dc.identifier.issn 0002-0729
  • dc.identifier.uri http://hdl.handle.net/10230/26075
  • dc.language.iso engca
  • dc.publisher Oxford University Pressca
  • dc.relation.ispartof Age Ageing. 2016 Mar;45(2):236-42
  • dc.rights © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society.This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work isproperly cited. For commercial re-use, please contact journals.permissions@oup.comca
  • dc.rights.accessRights info:eu-repo/semantics/openAccessca
  • dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/ca
  • dc.subject.other Epidemiologiaca
  • dc.subject.other Persones Gransca
  • dc.subject.other Osteoporosica
  • dc.title Clinical effectiveness of orthogeriatric and fracture liaison service models of care for hip fracture patients: population-based longitudinal study.ca
  • dc.type info:eu-repo/semantics/articleca
  • dc.type.version info:eu-repo/semantics/publishedVersionca

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