Study On The Effect Of Comprehensive Intervention On The Elderly With Hip Fracture Based On Continuity Of Care Model

ObjectivesTo analyze the postoperative characteristics of the elderly patients with hip fracture and verify the effect of comprehensive intervention on the elderly patients with hip fracture based on continuity of care model.MethodsA randomized controlled clinical trial design was used. From January2013to December2013in Tianjin Orthopedic hospital,82cases of elderly hip fracture patients (18patients were lost when follow-up) enrolled by convenience sampling, and randomly divided into intervention group (39cases) and control group (43cases) based on the inclusive criteria. There were no significant differences between patients of two groups in age, gender, educational level, marital status, fracture position, surgical procedure, complication etc (P>0.05). The control group received routine postoperative care. The intervention group received continuity of care and comprehensive intervention. The comprehensive intervention program included the implementation of the multidisciplinary collaboration care, comprehensive assessment, personalized health education, professional rehabilitation evaluation, tailor rehabilitation program for patients, discharge plan, telephone follow-up and family visits for three months. Discharge follow-up including health education, psychological support, complications prevention, rehabilitation training, osteoporosis secondary prevention, fall risk factors assessment and prevention. The Harris Hip Scale and the Functional and Independence Measure (FIM) were used to evaluate hip joint function and Functional Independence of patients at discharge，1month and3months post-discharge. At the3months post-discharge, patient’s balance ability was measured by the Berg Balance Scale (BBS) and the Timed Up and Go Test (TUGT). Patient’s drug treatment adherence was evaluated by the osteoporosis secondary prevention questionnaire survey. The health-related quality of life (HRQOL) of patients was measured by European five-dimensional health scale (EQ-5D) health self-evaluation questionnaire. Results1. The total score of Harris Hip Score were higher in the intervention group than in the control group at discharge,1month and3months post-discharge (P<0.05). Both of the two groups are on the rise trend.The total score of Harris Hip Score were significantly higher in the intervention group than in the control group at1month and3months post-discharge (P<0.01). The range of the total score change gradually increase over time. The three dimensions score of the Harris Hip Score(pain, function and joint mobility) in the intervention group were higher than the control group at discharge,1month,3months post-discharge (P<0.05).2. The total score of FIM were higher in the intervention group than in the control group at discharge,1month and3months post-discharge (P<0.05). Both of the two groups are on the rise trend.The total score of FIM were significantly higher in the intervention group than in the control group at1month and3months post-discharge (P<0.01). The range of the total score change gradually increase over time. The five dimensions score of the FIM(self-care, muscle control, transfer, walking, communication and social cognitive) in the intervention group were higher than the control group at discharge,1month,3months post-discharge (P<0.05).3. The results of balance test of the two groups at3months post-discharge:43.59%and18.60%of patients showed good balance ability respectively, BBS score>40points;56.41%and81.40%of patients in the intervention group and the control group respectively were in danger of falling, BBS score<40points. The proportion in two groups were statistical difference (P<0.05).33.33%,and13.95%of patients in the intervention group and control group respectively showed good balance function, TUGT test<30seconds;66.67%and86.05%of patients in the intervention group and control group respectively with poor balance functionwere in in danger of falling, TUGT test>30seconds. The proportion of two groups were statistical difference (P <0.05).4. The results of the adherence to osteoporosis drug:53.84%and16.28%of patients in the intervention group and the control group respectively kept taking bisphosphonates for3months post-discharge.30.77%and20.93%of patients respectively were taking bisphosphonates with interruption;15.39%and62.79%respectively did not take bisphosphonates.64.10%and23.26%of patients respectively kept daily calcium supplement≥600mg,28.20%,and48.84%of patients respectively were taking calcium with interruption,7.70%and27.90%of patients respectively did not taking calcium.48.72%and20.93%of patients respectively kept daily vitamin D of supplement≥400iu,35.90%and23.26%of patients respectively were taking vitamin D with interruption,15.38%and55.81%of patients respectively did not taking vitamin D. The adherence to osteoporosis drug of two groups were statistically significant (P<0.01).5. The results of EQ-5D in the two groups:accounted for38.46%and6.98%patients in the intervention group and control group respectively, whose activities ability had not difficult,53.85%and65.12%respectively had some difficult,7.69%and27.90%respectively had extremely difficult.20.51%and2.33%of patients respectively had ability of self-care with no difficult,61.54%and44.19%of patients respectively,with some difficult,17.95%and53.48%of patients, with extremely difficult.17.95%and2.33%of patients respectively had no problem in Daily life;51.28%and39.53%of patients respectively had some problem,30.77%and58.14%of patients respectively could not care.71.79%and44.19%of patients respectively had no pain and uncomfortable,23.08%and39.53%of patients respectively felt moderate pain/discomfort,5.13%and16.28%of patients respectively felt extremely pain.58.97%and25.58%of patients respectively were no anxiety/depression,28.21%and39.54%of patients respectively were mild anxiety/depression,12.82%and34.88%of patients respectively were moderate anxiety/depression.The EQ-5D of the two groups in the composition of the five dimensions of three level were statistically significant (P<0.05).Conclusion1. The elderly patients with hip fracture is a special and complex group, they are not only weak, functional disability, combined with variety of medical problems, but also have a lot of psychological and social problems, postoperative patients with subacute recovery faces significant challenges.2. Apply continuum care model and implement comprehensive intervention for elderly patients with hip fracture can not only promote the recovery of patients with hip function, also also improve the functional independence, balance ability, osteoporosis drug compliance and adherence of patients, thereby improving the patient’s quality of life.