Brigham Fracture Intervention Team Initiatives for Hospital Patients with Hip Fractures:A Paradigm Shift

[摘要] We designed, implemented, and revised the Brigham Fracture Intervention Team (B-FIT) initiatives to improve in-hospital care of fracture (Fx) patients. Effectiveness was evaluated for 181medical records of 4 cohorts in four successive years of consecutive patients who were admittedwith a fragility hip Fx. The Discharge Initiative (DI) (computer-based) includes 1200 mg calcium and1000 IU vitaminD3daily. The Admission Initiative (AI) was introduced one year later withreminders for serum 25OHD measurement, initiation of daily calcium (1200 mg) and vitamin D (800 IU), and an order for Endocrinology consultation, with an amendment for a computer-assistedreminder and a dose ofD2(50 000 IU). Initially, the computer-based DI was more effective (67%)than the surgeon-driven AI (33%,P<.001). After introduction of a computer-assisted reminder, AIeffectiveness increased to 68%. The marked prevalence of vitamin D insufficiency reaffirms theimportance of incorporating vitamin D recommendations in Fx care pathways.

[学科分类] 内分泌与代谢学