| 摘要: | Background: Little evidence is available on the longer-term effects (beyond 12 months) of
intervention models consisting of hip fracture-specific care in conjunction with
management of malnutrition, depression, and falls.
Objective: To compare the relative effects of an interdisciplinary care, and a comprehen-
sive care programme with those of usual care for elderly patients with a hip fracture on
self-care ability, health care use, and mortality.
Design: Randomised experimental trial.
Setting: A 3000-bed medical centre in northern Taiwan.
Participants: Patients with hip fracture aged 60 years or older (N = 299).
Method: Patients were randomly assigned to three groups: comprehensive care (n = 99),
interdisciplinary care (n = 101), and usual care (control) (n = 99). Usual care entailed only
one or two in-hospital rehabilitation sessions. Interdisciplinary care included not only
hospital rehabilitation, but also geriatric consultation, discharge planning, and 4-month
in-home rehabilitation. Building upon interdisciplinary care, comprehensive care
extended in-home rehabilitation to 12 months and added management of malnutrition
and depressive symptoms, and fall prevention. Patients’ self-care ability was measured by
activities of daily living and instrumental activities of daily living using the Chinese Barthel
Index and Chinese version Instrumental Activities of Daily Living scale, respectively.
Outcomes were assessed before discharge, and 1, 3, 6, 12, 18, 24 months following hip
fracture. Hierarchical linear models were used to analyse health outcomes and health care
utilisation, including emergency department visit and hospital re-admission. |
