日本骨折联络服务指南的影响以及引入新的骨折二级预防费用:在脆性骨折住院期间实施二级骨折预防。

IF 4.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Osteoporosis International Pub Date : 2025-02-01 Epub Date: 2024-12-13 DOI:10.1007/s00198-024-07269-0
Gaku Gondo, Jung-Ho Shin, Susumu Kunisawa, Yuichi Imanaka
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引用次数: 0

摘要

在日本,骨折联络服务临床标准(FLS-CS)的发布对骨折二级预防的实施没有明显影响,但新的骨折二级预防管理费的引入,明显促进了针对目标疾病的骨折二级预防的实施。背景:二级骨折预防对于脆性骨折的治疗非常重要。在日本,FLS-CS于2019年发布,同时于2022年推出了针对髋部骨折手术患者的二级骨折预防新管理费。FLS项目以医院为基础。本研究评估了这些干预措施对脆性骨折住院期间实施二级骨折预防的影响。方法:使用质量指标/改进项目数据库中的索赔数据,纳入50岁及以上接受手术或椎体骨折的髋部骨折患者。FLS-CS的发布是第一次干预,随后引入管理费作为第二次干预。为了评估这些干预措施的影响,我们分别对髋部和椎体骨折进行了中断时间序列分析。结果:髋部骨折患者,首次干预后无立即改变,每月变形率下降(发病率比[IRR]: 0.985, 95%可信区间[CI]: 0.979 ~ 0.991)。第二次干预后立即增加(IRR: 1.890, 1.761-2.029),月变化率也增加(IRR: 1.050, 1.044-1.056)。对于椎体骨折,只有在第二次干预后,改变的比例才立即增加(IRR: 1.148, 1.038-1.270)。结论:FLS-CS的发布对髋部或椎体骨折患者实施二级骨折预防无明显影响。相反,管理费的引入对目标疾病有增加的效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of the guidance on fracture Liaison Services and the introduction of a new fee for secondary fracture prevention in Japan: Implementation of secondary fracture prevention during hospitalization for fragility fractures.

In Japan, the publication of the Fracture Liaison Service Clinical Standard (FLS-CS) had no apparent effect on the implementation of secondary fracture prevention, but the introduction of a new management fee for secondary fracture prevention significantly promoted the implementation of secondary fracture prevention for the target disease.

Background: Secondary fracture prevention is important for managing fragility fractures. In Japan, the FLS-CS was published in 2019, alongside the introduction of a new management fee for secondary fracture prevention, launched in 2022 for patients who underwent surgery for hip fracture. FLS programs were hospital-based. This study evaluated the impact of these interventions on the implementation of secondary fracture prevention during hospitalization for fragility fractures.

Methods: Using claims data from the Quality Indicator/Improvement Project database, patients aged 50 years or older with hip fracture who underwent surgery or with vertebral fractures were included. The publication of FLS-CS was the first intervention, followed by the introduction of the management fee as the second intervention. To evaluate the impact of these interventions, we performed an interrupted time series analysis separately for hip and vertebral fractures.

Results: For hip fractures, there was no immediate change after the first intervention, and the monthly rate of change decreased (incidence rate ratio [IRR]: 0.985, 95% confidence interval [CI]: 0.979-0.991). After the second intervention, there was an immediate increase (IRR: 1.890, 1.761-2.029), and the monthly rate of change also increased (IRR: 1.050, 1.044-1.056). For vertebral fractures, the proportion of change increased only immediately after the second intervention (IRR: 1.148, 1.038-1.270).

Conclusion: The publication of FLS-CS had no apparent effect on the implementation of secondary fracture prevention in patients with either hip or vertebral fractures. Conversely, the introduction of the management fee had the effect of increasing that for the target disease.

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来源期刊
Osteoporosis International
Osteoporosis International 医学-内分泌学与代谢
CiteScore
8.10
自引率
10.00%
发文量
224
审稿时长
3 months
期刊介绍: An international multi-disciplinary journal which is a joint initiative between the International Osteoporosis Foundation and the National Osteoporosis Foundation of the USA, Osteoporosis International provides a forum for the communication and exchange of current ideas concerning the diagnosis, prevention, treatment and management of osteoporosis and other metabolic bone diseases. It publishes: original papers - reporting progress and results in all areas of osteoporosis and its related fields; review articles - reflecting the present state of knowledge in special areas of summarizing limited themes in which discussion has led to clearly defined conclusions; educational articles - giving information on the progress of a topic of particular interest; case reports - of uncommon or interesting presentations of the condition. While focusing on clinical research, the Journal will also accept submissions on more basic aspects of research, where they are considered by the editors to be relevant to the human disease spectrum.
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