Improving care for older fragility fracture patients Musculoskeletal Diseases Fracture of unspecified body region
Conditions
Interventions
Usual care (pre-cohort):
The control group receives usual care on the trauma ward. This means that the patient is cared for by a surgical resident. The interprofessional team furthermore consists of w
Sponsors
KU Leuven
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Aged 75 years and over at hospital admission 2. Admission on traumatology ward (E456) UZ Leuven due to new osteoporotic fracture: proximal femoral fracture, proximal humeral fracture, fracture of the pelvis/acetabulum, fracture of the thoracic/lumbar vertebrae (multiple fractures are allowed), fracture of the wrist
Exclusion criteria
Exclusion criteria: 1. Does not speak and/or understand Dutch 2. Palliative care setting (<3 months prognosis) 3. Multiple fractures (exception multiple vertebral fractures at the same moment) 4. Reoperation for surgical complication 5. Periprosthetic fracture 6. Concomitant joint infection
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| In-hospital complications (delirium, congestive heart failure, pneumonia, deep venous thrombosis, pulmonary embolism, myocardial infarction or urinary tract infection), measured by 4AT by: 1. Suspicion of delirium 2. Diagnosis of congestive heart failure based on the Modified Framingham Criteria 3. Diagnosis of pneumonia through imaging and laboratory testing according to local standard of care 4. Diagnosis of deep venous thrombosis confirmed on imaging (ultrasound) as per local standard of care 5. Diagnosis of pulmonary embolism confirmed on imaging through CT scans or radionuclide examination 6. Diagnosis of myocardial infarction defined as evidence of myocardial necrosis consistent with myocardial ischemia and urinary tract infection based on laboratory testing and relevant symptomatology All measured during hospitalization | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Patient outcomes: 1.1. Length of hospital stay defined as the total of days between admission and discharge at discharge 1.2. Quality of life measured using the EQ-5D at admission, discharge, 1, 3, 6 and 12 months post-discharge 1.3. Functional status and mobility measured using the Parker Mobility Score, modified Barthel Index/Katz index, Lawton and Brody Scale and at admission, discharge, 1, 3 and 6 months post-discharge 1.4. Hospital readmissions measured by a questionnaire and hospital records as any admission to hospital after discharge in the first 30 days post-discharge 1.5. Falls (“an unexpected event in which the patients comes to rest on the ground, floor or lower level”) and new fractures measured by a questionnaire at admission, in-hospital, at discharge, at 1, 3, 6 and 12 months post-discharge 1.6. Residential status defined in five categories: living alone at home, living with spouse/partner, living with children, assisted living, living in a facility with 24 h care such as a nursing home measured by a questionnaire at admission, discharge, 1, 3 and 12 months post-discharge 1.7. Mortality evaluation in-hospital at 1 and 12 months post-discharge 1.8. Secondary fracture prevention including documentation of fall risk assessment, medication review measured by a questionnaire and hospital records at admission, discharge, 1, 3, 6 and 12 months post-discharge 1.9. Nutritional status measured using the Mini Nutritional Assessment (MNA) at admission, 1, 3 and 6 months post-discharge 2. Process outcomes: 2.1. The reach of the program measured as % of patients aged 75 or older that are enrolled in the G-COMAN program, measured during hospitalization 2.2. The fidelity of the program measured as % of patients included in G-COMAN who had a screening or assessment focusing on delirium, nutritional status, pressure ulcer risk using a validated tool within 48 h of admission to traumatology ward, measured during hospitalization. 2.3. Time to start physiotherapy mea | — |
Countries
Belgium
Contacts
Public ContactSigrid Janssens
Outcome results
None listed