Track topics on Twitter Track topics that are important to you
The long-term objective of this study is to examine the effectiveness of an intervention program for older patients with hip fracture. First, an intervention program for elderly patients with hip fracture will be developed and implemented, then, the effectiveness of the intervention program will be examined. The specific aims are as follows:
1. To develop a well conceived and feasible protocol of hospital discharge and sub-acute care that involves the coordinated work of health care professionals (physicians, surgeons, nurses, and physical therapists) and the informal caregivers. The feasibility of implementing such a protocol within the context of an intervention study subject to the constraints of the clinical setting (i.e., CGMH) will be evaluated in a pilot study.
2. To conduct a randomized clinical trial to evaluate the outcomes and costs associated with the proposed hospital discharge/sub-acute care protocol for elderly patients with hip fracture. Both experimental and case study methods will be used. Information on outcome indicators including clinical outcomes, quality of life, self-care ability, family caregiving outcomes, patient and caregiver satisfaction, and services utilization will be collected and compared between the control group and the experimental group.
3. To conduct a validation clinical trial to verify the results of the primary randomized clinical trial and increase the generalization of the study findings.
4. To estimate the cost of this care model and its variations for individual patients.
1. Elderly patients with hip fracture who participate in the intervention program will significantly better clinical outcomes including range of motion (ROM), muscle strength and endurance, motor control, recovery of walking ability, aerobic and anaerobic capacity, flexibility, body position, and less pain, complications, and mortality than those who do not.
2. Elderly patients with hip fracture who participate in the intervention program will show significantly greater improvement in self-care ability measured by Chinese Functional Independence Measure (FIM) than those who do not.
3. Elderly patients with hip fracture who participate in the intervention program will significantly better quality of life measured by SF-36 Taiwan version than those who do not.
4. Elderly patients with hip fracture who participate in the intervention program will have significantly better family caregiving outcomes measured by the Family Caregiving Consequence Inventory (FCCI) than those who do not.
5. Elderly patients with hip fracture who participate in the intervention program will have significantly less health and personal service utilization including length of hospital stay (LOS), emergency room visits, hospital readmission rate, and home nursing, nursing home and other health service utilization than those who do not.
6. Elderly patients with hip fracture who participate in the intervention program and their family caregivers will have significantly more satisfaction to health care services than those who do not.
The percentage of elderly persons in Taiwan has continually increased, from 2.5% in 1951 to 8.26% in 1998; the current number of elderly is 1,811,335. As in other countries with an increasing aging population, hip fracture represents a major and growing health care problem in Taiwan. Hip fractures resulted in 15,000 hospital admissions in 1997. It is estimated that the incidence rate (per 100, 000) for hip fracture in Taiwan was 211 for Taiwan's elderly population in 1993, 10 times the incidence rate for the general population. Despite advanced treatments, the one-year mortality rate for hip fracture remains significant (15.4%), and a majority of patients never recover completely in terms of activities of daily living. The economic costs of hip fractures among the elderly are huge and families suffer from caregiving burdens. Many studies in the United States have shown that elderly patients with hip fracture can benefit from post-operative rehabilitation, early discharge planning, and transitional care. However, little is known about what interventions should be attempted for these patients and their family caregivers in Taiwan. The purpose of this experimental study is therefore to explore the effectiveness of an intervention program for older patients with hip fracture. The cost of this care model will also be estimated.
An intervention program will be developed in the first year. This program will be administered by a multidisciplinary health care team and will include a geriatric consultation service, an in-hospital and in-home rehabilitation program and a discharge planning component. During the first year, a pilot study consisting of 10 elderly patients with hip fracture and their caregivers in the experimental group and 10 in the control group will test the feasibility of the intervention program and establish a reference point for sample size modification. In the second and third years, a primary clinical trial will be conducted in Chang Gung Memorial Hospital in Lin Kuo. In this studies, 120 subjects who meet the sample criteria will be recruited and randomly assigned to the experimental and control group. Patients in the experimental group will receive regular hospital routine care and the intervention program. Patients in the control group will receive only routine hospital care. The outcome variables will include clinical outcomes, self-care ability, quality of life, family caregiving outcomes, patient and caregiver's satisfaction, and service utilization; data on those will be collected for one year after hospital discharge and compared between the experimental and control groups. Data on the cost of care will also be collected. A qualitative component will include in-depth interviews with five patients and their family caregivers from the experimental group, five from the control group and five health care providers, to explore the effects of the intervention program in detail. In the fourth and fifth years, a validation clinical trial will be conducted with 120 subjects. The intervention program will be implemented at a different medical center to validate the results of the primary clinical trial. The study results will provide suggestions for intervention protocols for elderly persons with hip fracture and guidelines for the development of intervention programs for other high-risk elderly persons in Taiwan. The findings also provide a reference for clinical and hospital administration decisions.
Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Single Blind (Subject), Primary Purpose: Supportive Care
Interdisciplinary intervention program
Chang Gung Memorial Hospital
Chang Gung Memorial Hospital
Published on BioPortfolio: 2014-08-27T03:16:32-0400
The main aim is to assess the effectiveness of introducing a standardized intervention program for treatment of fracture patients as measured by changes in the fracture rates and the morta...
Patients who have suffered a first hip fracture have a higher risk of falling and sustaining another hip fracture compared with age-matched adults who did not fracture. Although exercise i...
This is a one group pre-post feasibility study of an interdisciplinary (theatre, Occupational Therapy (OT) and Speech Language Pathology (SLP)) intervention targeted at social skill develo...
An intensive, interdisciplinary treatment program was administered during the summer as part of regular clinic services in the Aphasia Resource Center (ARC) at Sargent College. This progra...
The aim of the research study will be assess the effectiveness of a long-term interdisciplinary lifestyle in many aspects including food intake, psychological symptoms, physical activity h...
Communication among Interdisciplinary Healthcare Teams is an essential component of providing optimal patient care. Staff members at one U. S. Department of Veterans Affairs on an Acute Psychiatric Un...
We are not aware of any previous investigation assessing a national cohort of patients enrolled in a fracture liaison service (FLS) program in an open health-care system to ascertain prevalent practic...
Objectives To evaluate the women, infants, and children (WIC) Oral Health Program in a county in Florida. Methods The non-traditional interdisciplinary program of the current study was designed to rea...
Thyroid Cancer Patients Receiving an Interdisciplinary Team-Based Care Approach (ITCA-ThyCa) Appear to Display Better Outcomes: Program Evaluation Results Indicating a Need for Further Integrated Care and Support.
Thyroid cancer (ThyCa) is generally associated with a favorable prognosis and excellent surgical outcomes. Consequently, its treatment is medically focused and current guidelines recommend interdiscip...
Chronic pain is one of the most common, disabling, and expensive public health problems in the United States. Interdisciplinary pain management treatments that employ behavioral approaches have been s...
Implantable fracture fixation devices attached to bone fragments with screws to bridge the fracture gap and shield the fracture site from stress as bone heals. (UMDNS, 1999)
Fracture in the proximal half of the shaft of the ulna, with dislocation of the head of the radius.
The use of metallic devices inserted into or through bone to hold a fracture in a set position and alignment while it heals.
Fracture of the lower end of the radius in which the lower fragment is displaced posteriorly.
The use of internal devices (metal plates, nails, rods, etc.) to hold the position of a fracture in proper alignment.
Osteoporosis is a disease in which the bones become extremely porous, are subject to fracture, and heal slowly, occurring especially in women following menopause and often leading to curvature of the spine from vertebral collapse. Follow and track&n...
Within medicine, nutrition (the study of food and the effect of its components on the body) has many different roles. Appropriate nutrition can help prevent certain diseases, or treat others. In critically ill patients, artificial feeding by tubes need t...
In a clinical trial or interventional study, participants receive specific interventions according to the research plan or protocol created by the investigators. These interventions may be medical products, such as drugs or devices; procedures; or change...