Medico-Social Collaboration for Patients Hospitalised for Hip Fracture in New Territories East Cluster

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Authors (including presenting author) :
Ma HM (1), Lai KS (1), Lee SW (1), Wong WK (1), Chim CK (1), Siu HK (2), Yu SY (3), Law SW (4), Tang N (5), Ho PC (4)(5)(6), Wong WB (7), Hui E (1)
Affiliation :
1. Community Outreach Services Team, New Territories East Cluster (NTEC) 2. Cluster Coordinator (Physiotherapy), New Territories East Cluster (NTEC) 3. Cluster Coordinator (Occupational Therapy), New Territories East Cluster (NTEC) 4. Department of Orthopaedic Rehabilitation, Tai Po Hospital (TPH) 5. Department of Orthopaedics and Traumatology, Prince of Wales Hospital (PWH) 6. Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital (AHNH) 7. Department of Orthopaedics and Traumatology, North District Hospital (NDH)
Introduction :
Hip fracture is a devastating outcome of falls in elderly people because it is commonly associated with disability. There is a pressing need for a community rehabilitation programme so that patients can regain independence in activities of daily living after hip fracture surgery. Moreover, it may take up to six months for patients to reach their plateau in regaining self-care ability. Thus, Integrated Care Model (ICM) has extended its service to all elderly patients (aged ≥60) hospitalised for hip fracture in NTEC since January 2018. The team consists of geriatricians, link nurses, physiotherapists (PT), occupational therapists (OT) and medical social workers. The beauty is the collaboration between Hospital Authority and Social Welfare Department in the co-care of patients during the transitional period of time, i.e. between discharge from hospital and achieving the plateau of self-care ability. Its goal is to fill the service gap by proactive pre-discharge planning, post-discharge domiciliary rehabilitation and medical support, and social support (community or respite service).
Objectives :
This study aims to evaluate the effectiveness of this collaborative service in terms of patients’ functional outcome and hospital length of stay (LOS).
Methodology :
(1) Modified Functional Ambulation Classification (MFAC): Functional assessment of patients on the first and last home visits by case manager (PT or OT) (2) Length of stay (LOS) in 3 acute hospitals (PWH, AHNH and NDH) and convalescence hospital (TPH) in 2017 and 2018
Result & Outcome :
Results: A total of 730 patients were hospitalised for hip fracture in 3 acute hospitals from January to September 2018. Of them, 318 patients (71% female and mean age of 81.6 years) were recruited after pre-discharge planning conducted by link nurses in Orthopeadic wards. The recruited patients underwent an 8-week domiciliary rehabilitation. A majority (75%, 239 patients) could achieve an improvement in functional status. Over half of them (59%, 188 patients) could have full functional recovery, i.e. MFAC back to the premorbid level as an independent walker. The average LOS of 3 acute hospitals and TPH were reduced as follows: PWH – 10.4 days to 9.7 days; AHNH – 10.5 days to 9.5 days; NDH – 11.2 to 10.4 days; and TPH – 21.0 days to 17.1 days. Conclusion: This collaborative service speeds up the discharge of elderly patients with hip fracture from hospital and facilitates domiciliary rehabilitation. We may explore the feasibility of medico-social collaborative model in other common geriatric diseases, such as stroke and chronic pulmonary diseases.

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