Abstract：
Patients who sustain a hip fracture are known to be at imminent refracture risk. Their complex multidisciplinary rehabilitation needs to include falls prevention and anti-osteoporosis medication (AOM) to prevent such fractures. This study aimed to determine which hospital-level organisational factors predict prescription of post-hip fracture AOM, and refracture risk. A cohort of 178 757 patients aged ≥60 years who sustained a hip fracture in England and Wales (2016-19) was examined and followed for 1 year. Patient-level hospital admission datasets from 172 hospitals, the National Hip Fracture Database, and mortality data were linked to 71 metrics extracted from 18 hospital-level organisational reports. Multilevel models determined organisational factors, independent of patient case-mix, associated with (i) AOM prescription, (ii) refracture (by ICD10 coding). Patients were mean (SD) 82.7 (8.6) years old, 71% female, with 18% admitted from care homes. Overall, 101 735 (57%) were prescribed AOM during admission; while 50 354 (28%) died during 1-year follow-up, 12 240 (7%) refractured. Twelve organisational factors were associated with AOM prescription, e.g., orthogeriatrician-led care compared to traditional care models (OR 4.65 [95%CI: 2.25-9.59]); AOM was 9% (95%CI: 6%-13%) more likely to be prescribed in hospitals providing routine bone health assessment to all patients. Refracture occurred at median 126 days (IQR 59-234). Eight organisational factors were associated with refracture risk; hospitals providing orthogeriatrician assessment to all patients within 72-hours of admission had an 18% (95%CI: 2-31%) lower refracture risk, weekend physiotherapy provision an 8% (95%CI: 3-14%) lower risk, and where occupational therapists attended clinical governance meetings, a 7% (95%CI: 2-12%) lower risk. Delays initiating post-discharge community rehabilitation were associated with a 15% (95%CI: 3-29%) greater refracture risk. These novel, national findings highlight the importance of orthogeriatrician, physiotherapist and occupational therapist involvement in secondary fracture prevention post hip fracture; notably fracture risk reductions were seen within 12 months of hip fracture.
Patients who have broken (fractured) a hip are at risk of having another fracture soon after. They have complex needs to avoid more fractures, which include being prescribed bone-strengthening medicines and taking measures to prevent falls. This study looked at which of the measurements, that describe how well a hospital is organised, are associated with whether bone-strengthening medicine is prescribed and the chance of having another fracture. We used data from 178 757 patients aged over 60 years who had a hip fracture at 172 English and Welsh hospitals, linked to their hospital records, and other datasets that describe hospital services. Overall, 57% of patients were prescribed bone-strengthening medicines, and 7% went on to have another fracture. Bone-strengthening medicines were more likely to be prescribed in hospitals where patient care was led by a consultant specialising in the care of older people with fractures (called orthogeriatricians) and in hospitals which routinely checked patients’ bone health. Patients attending hospitals that provided orthogeriatrician assessment to all patients within 72 hours of being admitted, physiotherapy services at the weekend, or where occupational therapists attended meetings aimed at improving hospital services had a lower chance of having another fracture.
Patients who have broken (fractured) a hip are at risk of having another fracture soon after. They have complex needs to avoid more fractures, which include being prescribed bone-strengthening medicines and taking measures to prevent falls. This study looked at which of the measurements, that describe how well a hospital is organised, are associated with whether bone-strengthening medicine is prescribed and the chance of having another fracture. We used data from 178 757 patients aged over 60 years who had a hip fracture at 172 English and Welsh hospitals, linked to their hospital records, and other datasets that describe hospital services. Overall, 57% of patients were prescribed bone-strengthening medicines, and 7% went on to have another fracture. Bone-strengthening medicines were more likely to be prescribed in hospitals where patient care was led by a consultant specialising in the care of older people with fractures (called orthogeriatricians) and in hospitals which routinely checked patients’ bone health. Patients attending hospitals that provided orthogeriatrician assessment to all patients within 72 hours of being admitted, physiotherapy services at the weekend, or where occupational therapists attended meetings aimed at improving hospital services had a lower chance of having another fracture.
摘要：
已知患有髋部骨折的患者处于即将发生的再骨折风险。他们复杂的多学科康复需要包括预防跌倒和抗骨质疏松药物（AOM）以防止此类骨折。本研究旨在确定哪些医院级别的组织因素可以预测髋部骨折后AOM的处方。和再骨折的风险。在英格兰和威尔士（2016-19）接受了174757名年龄≥60岁的髋部骨折患者的队列检查并随访了1年。来自172家医院的患者级住院数据集，国家髋部骨折数据库,死亡率数据与从18份医院级组织报告中提取的71项指标相关联.多层次模型确定了组织因素，独立于患者病例组合，与(I)AOM处方相关，(ii)再断裂(通过ICD10编码)。患者平均（SD）82.7（8.6）岁，71%为女性,18%的人从养老院入院。总的来说,101735（57％）在入院期间规定了AOM；而50354（28％）在1年随访期间死亡，12240（7%）折射。12个组织因素与AOM处方相关，例如，与传统护理模式相比(OR4.65[95CI:2.25-9.59]);在向所有患者提供常规骨健康评估的医院中,使用AOM的可能性高出9%(95CI:6%-13%).再骨折发生在中位数126天（IQR59-234）。八个组织因素与再骨折风险相关；在入院72小时内向所有患者提供矫形儿科医生评估的医院再骨折风险降低了18％（95CI：2-31％）。周末物理治疗提供8%(95CI:3-14%)的风险降低，职业治疗师参加了临床治理会议，风险降低7%(95CI:2-12%)。延迟启动出院后社区康复与15%(95CI:3-29%)的再骨折风险相关。这些小说,国家研究结果强调了矫形儿科医生的重要性，物理治疗师和职业治疗师参与了髋部骨折后的二次骨折预防;值得注意的是，髋部骨折后12个月内骨折风险降低。
髋部骨折（骨折）的患者在不久后有再次骨折的风险。他们有复杂的需求来避免更多的骨折，其中包括开强骨药物和采取措施防止跌倒。这项研究着眼于哪种测量，描述医院组织得有多好，与是否开了强骨药以及再次骨折的机会有关。我们使用了来自172个英国和威尔士医院的178,757名年龄超过60岁的髋部骨折患者的数据，和他们的医院记录有关,和其他描述医院服务的数据集。总的来说,57%的患者服用了强骨药物,7%的人再次骨折。骨强化药物更有可能在由专门为骨折老年人提供护理的顾问领导的医院和定期检查患者骨骼健康的医院中开药。在入院后72小时内向所有患者提供骨科医师评估的医院就诊的患者，周末的理疗服务，或者职业治疗师参加旨在改善医院服务的会议的地方发生另一次骨折的可能性较低。
髋部骨折（骨折）的患者在不久后有再次骨折的风险。他们有复杂的需求来避免更多的骨折，其中包括开强骨药物和采取措施防止跌倒。这项研究着眼于哪种测量，描述医院组织得有多好，与是否开了强骨药以及再次骨折的机会有关。我们使用了来自172个英国和威尔士医院的178,757名年龄超过60岁的髋部骨折患者的数据，和他们的医院记录有关,和其他描述医院服务的数据集。总的来说,57%的患者服用了强骨药物,7%的人再次骨折。骨强化药物更有可能在由专门为骨折老年人提供护理的顾问领导的医院和定期检查患者骨骼健康的医院中开药。在入院后72小时内向所有患者提供骨科医师评估的医院就诊的患者，周末的理疗服务，或者职业治疗师参加旨在改善医院服务的会议的地方发生另一次骨折的可能性较低。
