The department of orthopaedics and the division of geriatrics and gerontology of the department of internal medicine started the integrated geriatric comprehensive care plan of osteoporotic fracture patients in the Kaohsiung Medical University Hospital since 2012 September. Under the support of our hospital, we set the first ortho-geriatric co-care ward in Taiwan in 2015. We integrated the experts and resources in our hospital to care the fragile patients with multi-comorbidities and complex needs. We provide the comprehensive geriatric assessment and interventions to those patients. The patient-days under our services are more than one thousand.
Our team won the best practice recognition (the gold medal) of the Fracture Liaison Service in the global exercise “capture the fracture” by the International Osteoporosis Foundation in 2016 May. There were only four hospitals in the Asia get the gold medal recognition at that time.
We first provided the comprehensive co-care to the elder osteoporotic fracture patients in Taiwan in large scale. The care model significantly reduces the hospitalization days, readmission rates in 3 months, emergency room visits in 3 months and the mortality in one year of the elder osteoporotic fracture patients. The one-year-mortality rate reduces more than 50 percent after the care-model started and is significantly less than the rate reported in our national health insurance database.
The orthopediologists start co-care service depending on the need of the elder osteoporotic fracture patients. The ortho-geriatric team will co-care the patients with complex needs for several days. There are orthopediologist, the geriatrician, the neurologist, the psychiatrist, the doctor of physical medicine and rehabilitation, the occupational therapist, the physical therapist, the nurses, the case manager, the health educator, the dietitian, the social worker and the pharmacist in the team. We treat the osteoporotic fracture patients’ complex co-morbidities, reduce the unnecessary drugs and the drug-drug/drug-disease interaction, modify the diet prescription, systemically evaluate and treat the risk factors of fall and osteoporosis, provide training of the gait and balance, recommend the proper assistive devices, plan the dislocation after the discharge and care transition, introduce the social resources to the care-givers and the patients. The care is integrated by the geriatrician and delivered as the patients’ need after the comprehensive assessment. After the discharge, we provide the integrated care in the orthopediologic outpatient department and the integrated geriatric outpatient department.
The most distinctive advantage is the fracture liaison services and the comprehensive geriatric care provided by the integrated multidispilinary team.