The Effectiveness of a Co-Management Care Model on Older Hip Fracture Patients in China – A Multicentre Non-Randomised Controlled Study

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Abstract
Background: Clinical guidelines recommend orthogeriatric care to improve older hip fracture patients’ outcomes, but few studies have been conducted in China. This study evaluated the effectiveness of an orthogeriatric co-management care model in six Chinese hospitals. Methods: This non-randomised controlled study was conducted in 3 urban and 3 suburban hospitals. Eligible patients were aged ≥ 65 years with X-ray confirmed hip fracture and admitted to hospital within 21 days of injury. All patients received one year of follow-up. Co-managed care was implemented in 1 urban hospital, while usual care continued in 5 hospitals. Patient demographics, pre-, peri- and post-operative information, complications and mortality were collected at baseline, one, four, and twelve months. The primary outcome was proportion of patients receiving surgery within 48 hours from ward arrival. Secondary outcomes included various clinical assessments and length of hospital stay, with one-year mortality as an exploratory outcome. Findings: There were 2,071 eligible patients enrolled (1,110 intervention, 961 control). Compared to usual care, a significantly higher proportion of intervention patients received surgery within 48 hours (75% vs 27%, p<0 . 0001), osteoporosis assessment (99 . 9% vs 60 . 6%, p<0 . 0001), geriatrician assessment (97 . 7% vs 0, p<0 . 0001) and rehabilitation (99 . 1% vs 3 . 9%, p<0 . 0001). One-year mortality was significantly reduced in the intervention group (hazard ratio 0 . 59, 95% CI 0.38 to 0.80, p=0 . 01). Interpretation: Co-management care of older hip fracture patients resulted in better outcomes, including decreased time to surgery, improved clinical management, and reduced one-year mortality. A randomised controlled trial would provide more robust evidence. Funding Statement: The study is supported by Capital’s Funds for Health Improvement and Research (2018-1- 2071). JZ is supported by the University of International Postgraduate Award (UIPA) from University of New South Wales. RW is supported by a National Health and Medical Research Council Early Career Researcher Fellowship (APP1125044); RI is supported by a National Health and Medical Research Council Senior Research Fellowship. Declaration of Interests: All authors have not any conflict of interest to this study and have provided a conflict of interest statement. Ethics Approval Statement: Ethics approvals were received from the Institutional Review Board at Peking University Health Science Centre (IRB00001052-17021) and Biomedical Ethics Committee at Beijing Jishuitan Hospital (201807-11). All informed participants provided written consent. Trial Registration: The study was registered at Clinicaltrials.gov (NCT03184896).

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