2022年4月，日本厚生省实施了一项新的髋部骨折报销计划。日本是世界上老龄化程度最高的社会之一，面临着骨质疏松症和脆性骨折严重且迅速增长的负担。髋部骨折的发病率预计将从 2020 年的 240,000 例增加到 2040 年的 320,000 例。2015 年，日本脆性骨折网络 (FFN-Japan) 正式成立为非营利组织，旨在创建日本最佳的脆性骨折护理系统。 FFN-Japan 于 2017 年推出了日本国家髋部骨折数据库 (JNHFD)，最初日本只有 8 家参与医院。 2017年5月至2020年底，16家医院在JNHFD登记的患者人数，在此期间登记的患者总数为4271人。 FFN-Japan 邀请厚生劳动省 (MHLW) 的官员参加圆桌会议，讨论 JNHFD 收集的数据，并考虑在全国范围内改善髋部骨折护理的机会。入院36小时内接受手术的患者比例，2018年为48.1%，2019年为58.6%，2020年为44.9%，存在手术延迟现象。在骨折二级预防方面，2018年住院患者中开始骨质疏松症治疗的比例为60.2%，2019年为54.0%，2020年为64.5%，表明骨折后护理不足。 2022年4月，日本厚生劳动省中央社会保险医疗委员会宣布了一项新的髋部骨折护理报销计划，包括两个关键部分：早期手术（受伤后48小时内）和骨折后立即进行二级骨折预防。 日本新的髋部骨折护理报销计划将促进和巩固急性多学科护理和骨折后护理以及二级骨折预防的重大改进。 FFN-Japan 通过与政府的密切合作和持续沟通，在卫生系统的这些政策变化中发挥了关键作用。 JNHFD 成立五年内，FFN-Japan 与日本政府富有远见的领导人合作，成功实现了日本卫生系统髋部骨折护理报销的重大改革。这项改革为这种使人衰弱、危及生命的伤害的管理方式转变奠定了基础，目前每年有近 25 万日本老年人遭受这种伤害。
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Fragility Fracture Network-Japan: The challenge of establishment of a national hip fracture database and successful achievement of nationwide health system change for hip fracture care in Japan
In April 2022, a new reimbursement scheme for hip fracture was implemented by the Japanese health ministry. Japan is one of the world's most aged societies, facing a significant, rapidly growing burden of osteoporosis and fragility fractures. The incidence of hip fractures is projected to increase from 240,000 in 2020 to 320,000 by 2040. In 2015, Fragility Fracture Network-Japan (FFN-Japan) was formally established as a nonprofit organization in order to create the optimal fragility fracture care system in Japan. FFN-Japan launched the Japan National Hip Fracture Database (JNHFD) in 2017, initially with only eight participating hospitals across Japan. The number of patients enrolled from May 2017 to the end of 2020 in the JNHFD from the 16 hospitals registered the patients during this period with amounting to 4271 patients in total. FFN-Japan invited officials from the Ministry of Health, Labor and Welfare (MHLW) to participate in round table meetings to discuss the data collected in the JNHFD and to consider opportunities for nationwide improvement in hip fracture care. The proportion of patients who underwent surgery within 36 h of arrival at hospital was 48.1% in 2018, 58.6% in 2019, and 44.9% in 2020 indicating the delay of surgery. Regarding secondary fracture prevention, initiation of osteoporosis treatment during the in-patients was 60.2% in 2018, 54.0% in 2019, and 64.5% in 2020 indicating the inadequate post fracture care. In April 2022, the Central Social Insurance Medical Council of the Japanese MHLW announced a new reimbursement scheme for hip fracture care including two key components: Early surgery (within 48 h from injury) and Secondary fracture prevention immediately after fracture. The new reimbursement scheme of hip fracture care in Japan will catalyze and underpin major improvements on acute multidisciplinary care and post-fracture care with secondary fracture prevention. FFN-Japan played a key role on these policy changes to the health system by means the close collaboration and ongoing communication with the government. Within five years of establishment of the JNHFD, FFN-Japan in collaboration with visionary leaders from the Japanese government have successfully achieved a major reform of the Japanese health system's reimbursement of hip fracture care. This reform has laid the foundation for transformation of management of this debilitating and life-threatening injury that currently afflicts almost a quarter of a million older Japanese citizens each year.
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