以骨折聯合照護服務建構個案管理網絡系統

The Success of Fracture Liaison Service in Hip Fracture: Effective in Reducing Mortality

隨著全球人口老化比例逐漸增加，脆弱性骨折的個案數也隨之快速增多，台灣每年髖骨骨折的發生人數從2010年的18,338人，預計在2035年將會增加2.7倍至50,421人。根據過去的研究發現，即便是有脆弱性骨折的個案，得到完整骨質疏鬆症評估與治療的個案比例，通常不到三分之一，尤其發生於髖部的脆弱性骨折，可能造成高死亡率與失能的問題，這類病患一年內的死亡率可高達20%，而約30%的個案可能產生永久性的失能，約40%的個案無法獨立行走，由此可知脆弱性骨折為社會帶來更多長期照護的難題，因此，預防脆弱性骨折的發生成為目前重要課題。目前台灣已有多項慢性疾病透過個案管理網絡系統顯著減少相關併發症的發生率。為減少脆弱性骨折所帶來的併發症及社會成本，應儘速建立以骨折聯合照護服務的個案管理網絡系統，此系統從辨識脆弱性骨折的潛在高危險個案，為其提供個案良好評估與生活衛教，進而給予適當的介入治療與定期追蹤，同時為了提高個案管理架構的效率，資訊系統的輔助成為不可或缺的重要工具。本文旨在探討於某大型醫院以骨折聯合照護服務，建構個案管理網絡架構的建立過程。

Abstract: With the aging of population, osteoporosis becomes the 2nd prevalent disease in the world. The incidence of hip fracture in Taiwan is highest in Asia and 9th in the world. Osteoporotic fractures usually occur in spine, wrist and hip. Previous studies revealed high mortality rate during hospitalization in hip fracture as high as 9.5% and 36% one year mortality. The risk of re-fracture increases after the first hip fracture and about half of the patients with hip fracture will have re-fracture in the hip. Fracture Liaison Services, commonly known as FLS, are coordinator-based, secondary fracture prevention services implemented by health care systems for the treatment of osteoporotic patients. The FLS is designed to close the care gap for fracture patients, 80% of whom are currently never offered screening and/or treatment for osteoporosis. The FLS in Kaohsiung Medical University Hospital is run by coordinator and the specialists from Orthopedic department and Geriatric department. We screened all patients with hip fracture admitted in Orthopedic department for FLS. In 136 patients in Kaohsiung Medical University Hospital, the one year mortality rate is 2.9%. In 76 patients in Kaohsiung Municipal Ta-Tung Hospital, the one year mortality rate is 2.6%. Overall, one year mortality is 2.8% after FLS. The most important part to reduce mortality is to treat co-morbidities. Controlling co-morbidities during hospitalization and urging patients to receive treatment of co-morbidities in addition to their treatment of osteoporosis contacted by coordinator is the key to reduce mortality.