Programa de atención integral a pacientes mayores de 65 años con fractura de cadera / Comprehensive care program for elderly patients over 65 years with hip fracture

Objetivos. Presentamos los resultados en salud de un programa de asistencia multidisciplinar a pacientes con fractura de cadera mayores de 65 años. Pacientes y métodos. Hemos desarrollado un modelo de coordinación asistencial para la atención integral del paciente con fractura de cadera, estableciendo qué, quién, cuándo, cómo y dónde intervienen traumatólogos, internistas, médicos de familia de urgencias, intensivistas, fisioterapeutas, anestesistas, enfermeros y trabajadores sociales. Se evaluaron retrospectivamente todos los pacientes mayores de 65 años que ingresaron con diagnóstico de fractura de cadera (años 2006 a 2010). Resultados. Se incluyen 1.000 episodios de fractura de cadera ocurridos en 956 pacientes. La edad media fue de 82 años y la estancia media de 6,7 días, reduciéndose 1,14 días en los 5 años del programa. Antes de las 72h se intervinieron el 85,1%, y el 91,2% a lo largo del programa. La incidencia de infección quirúrgica fue del 1,5% y la mortalidad intrahospitalaria del 4,5% (24,2% a los 12 meses). Al cabo de un año reingresaron el 14,9%, y el 40% de los enfermos consiguieron ser independientes para las actividades básicas de su vida diaria. Conclusiones. Este programa de atención multidisciplinar al paciente con fractura de cadera se asoció a resultados beneficiosos en salud, con un elevado porcentaje de pacientes intervenidos precozmente (más del 90%), una reducida estancia media (menos de 7 días), incidencia de infecciones quirúrgicas, reingresos y mortalidad intrahospitalaria y al año de seguimiento, así como una adecuada recuperación funcional (AU)

Objectives. To report the health outcomes of a multidisciplinary care program for patients over 65 years with hip fracture. Patients and methods. We have developed a care coordination model for the comprehensive care of hip fracture patients. It establishes what, who, when, how and where orthopedists, internists, family physicians, emergency, intensive care, physiotherapists, anesthetists, nurses and workers social intervene. All elderly patients over 65 years admitted with the diagnosis of hip fracture (years 2006 to 2010) were retrospectively evaluated. Results. One thousand episodes of hip fracture, corresponding to 956 patients, were included. Mean age was 82 years and mean stay 6.7 days. This was reduced by 1.14 days during the 5 years of the program. A total of 85.1% were operated on before 72 yours, and 91.2% during the program. Incidence of surgical site infection was 1.5%. In-hospital mortality was 4.5%, (24.2% at 12 months). Readmissions at one years was 14.9%. Independence for basic activity of daily living was achieved by 40% of the patients. Conclusions. This multidisciplinary care program for hip fracture patients is associated with positive health outcomes, with a high percentage of patients treated early (more than 90%), reduced mean stay (less than 7 days), incidence of surgical site infections, readmissions and inpatient mortality and at one year, as well as adequate functional recovery (AU)

Comprehensive care program for elderly patients over 65 years with hip fracture.

OBJECTIVES: To report the health outcomes of a multidisciplinary care program for patients over 65 years with hip fracture. PATIENTS AND METHODS: We have developed a care coordination model for the comprehensive care of hip fracture patients. It establishes what, who, when, how and where orthopedists, internists, family physicians, emergency, intensive care, physiotherapists, anesthetists, nurses and workers social intervene. All elderly patients over 65 years admitted with the diagnosis of hip fracture (years 2006 to 2010) were retrospectively evaluated. RESULTS: One thousand episodes of hip fracture, corresponding to 956 patients, were included. Mean age was 82 years and mean stay 6.7 days. This was reduced by 1.14 days during the 5 years of the program. A total of 85.1% were operated on before 72 yours, and 91.2% during the program. Incidence of surgical site infection was 1.5%. In-hospital mortality was 4.5%, (24.2% at 12 months). Readmissions at one years was 14.9%. Independence for basic activity of daily living was achieved by 40% of the patients. CONCLUSIONS: This multidisciplinary care program for hip fracture patients is associated with positive health outcomes, with a high percentage of patients treated early (more than 90%), reduced mean stay (less than 7 days), incidence of surgical site infections, readmissions and inpatient mortality and at one year, as well as adequate functional recovery.

[Continuity of medical care. Evaluation of a collaborative program between hospital and Primary Care]. / Continuidad asistencial. Evaluación de un programa de colaboración entre Atención Hospitalaria y Atención Primaria.

The patients being treated in our health care system are becoming increasingly older and have a greater prevalence of chronic diseases. Due to these factors, these patients require greater and easier accessibility to the system as well as continuity of medical care. Collaboration between the different levels of health care has been instrumental in the success of the system and has produced changes in the hospital medical care protocol. Our hospital has developed a care model oriented towards the patient's needs, resulting in a higher grade of satisfaction among the medical professionals. In this paper, we have given a detailed description of part of our medical model, illustrating its different components and indicating several parameters of its evaluation. We have also reviewed the current state of the various models published on this topic. In summary, we believe that this medical care model presents a different approach to management that benefits patients, medical professionals and the health system alike.

Continuidad asistencial. Evaluación de un programa de colaboración entre Atención Hospitalaria y Atención Primaria / Continuity of medical care. Evaluation of a collaborative program between hospital and Primary Care

Los pacientes atendidos en nuestro sistema sanitario tienen cada vez más edad y mayor prevalencia de enfermedades crónicas. Estas características de salud han condicionado que entre las expectativas de mayor relevancia de los pacientes, se indiquen la accesibilidad al sistema y la continuidad en los cuidados. La colaboración entre los distintos niveles asistenciales ha sido una herramienta reconocida que facilita la consecución de estas expectativas, provocando cambios en la organización del trabajo. Nuestro hospital ha desarrollado un modelo de atención sanitaria que ­en su orientación al enfermo­ facilita la colaboración entre los distintos niveles asistenciales, consiguiendo un grado de satisfacción de los profesionales elevado. En este trabajo se describe detalladamente parte del modelo, mostrando los elementos que lo caracterizan, indicando algunos parámetros de la evaluación de resultados y revisando la situación de los modelos de continuidad asistencial publicados. En resumen, consideramos que este sistema asistencial está dotado de elementos de gestión que permiten atender las expectativas de los usuarios, aportando beneficios para el paciente, el profesional y el sistema sanitario (AU)

The patients being treated in our health care system are becoming increasingly older and have a greater prevalence of chronic diseases. Due to these factors, these patients require greater and easier accessibility to the system as well as continuity of medical care. Collaboration between the different levels of health care has been instrumental in the success of the system and has produced changes in the hospital medical care protocol. Our hospital has developed a care model oriented towards the patient's needs, resulting in a higher grade of satisfaction among the medical professionals. In this paper, we have given a detailed description of part of our medical model, illustrating its different components and indicating several parameters of its evaluation. We have also reviewed the current state of the various models published on this topic. In summary, we believe that this medical care model presents a different approach to management that benefits patients, medical professionals and the health system alike (AU)