Evaluation of the effectiveness of a care program for elderly patients with hip fractures: a network strategy

Abstract Objective: Evaluate the effectiveness of a care program for elderly persons with hip fractures due to a fall, based on a public network in Canoas, Rio Grande do Sul, Brazil. Methods: a prospective cohort study of quantitative character was carried out. A total of 182 elderly person above 60 years diagnosed with hip fractures were included. The sample was divided into two groups, one who underwent their usual treatment (n=91) and another who were included in a care program for elderly persons with hip fractures (n=91). The program had as its main axis a clinical Protocol and an Access Protocol. The treatment of choice was surgical in all cases. In statistical analysis, categorical variables were described by absolute and relative frequencies. The Mann-Whitney test was used to compare numeric variables. In the comparison of proportions, the Pearson's Chi-squared test or Fisher's exact test were applied. The significance level adopted was 5%. Results: The average age was 79.4 years, with a prevalence of the female gender. The most frequent morbidity was hypertension. After the implementation of the program there was a reduction in the average time between the fracture and the beginning of surgery, the average length of hospitalization, the urinary tract infection rate, the death rate and care costs. Conclusion: The care program of elderly persons with hip fractures modified the expected results as it reduced mortality, average hospital stay, postoperative complications and the costs of treatment during the hospitalization.

摘要
研究目的：评估巴西南里奥格兰德州卡诺阿斯市公立医疗网络中，针对跌倒引发髋部骨折的老年患者的照护方案的有效性。
研究方法：本研究为定量前瞻性队列研究。共纳入182例年龄超过60岁、确诊髋部骨折的老年患者。将研究样本分为两组：常规治疗组（n=91）与髋部骨折老年患者照护方案组（n=91）。该照护方案以临床规程（Protocol）与就诊准入规程（Access Protocol）为核心框架。所有受试者均接受手术治疗。统计学分析中，分类变量以绝对频数与相对频数进行描述；数值变量组间比较采用曼-惠特尼U检验（Mann-Whitney test）；组间比例比较采用皮尔逊卡方检验（Pearson's Chi-squared test）或费希尔精确检验（Fisher's exact test），检验水准设定为5%。
研究结果：受试者平均年龄为79.4岁，女性占比更高。最常见的合并症为高血压。实施该照护方案后，骨折至手术开始的平均间隔时间、平均住院时长、尿路感染发生率、死亡率及照护成本均有所降低。
研究结论：针对跌倒所致髋部骨折老年患者的照护方案可改善预期结局，具体表现为降低死亡率、缩短平均住院时长、减少术后并发症及降低住院期间的治疗总成本。