Objectives: to evaluate orthogeriatric and nurse-led fracture liaison service (FLS) models of post-hip fracture care in terms of impact on mortality (30 days and 1 year) and second hip fracture (2 years).Setting: Hospital Episode Statistics database linked to Office for National Statistics mortality records for 11 acute hospitals in a region of England.Population: patients aged over 60 years admitted for a primary hip fracture from 2003 to 2013.Methods: each hospital was analysed separately and acted as its own control in a before–after time-series design in which the appointment of an orthogeriatrician or set-up/expansion of an FLS was evaluated. Multivariable Cox regression (mortality) and competing risk survival models (second hip fracture) were used. Fixed effects meta-analysis was used to pool estimates of impact for interventions of the same type.Results: of 33,152 primary hip fracture patients, 1,288 sustained a second hip fracture within 2 years (age and sex standardised proportion of 4.2%). 3,033 primary hip fracture patients died within 30 days and 9,662 died within 1 year (age and sex standardised proportion of 9.5% and 29.8%, respectively). The estimated impact of introducing an orthogeriatrician on 30-day and 1-year mortality was hazard ratio (HR) = 0.73 (95% CI: 0.65–0.82) and HR = 0.81 (CI: 0.75–0.87), respectively. Following an FLS, these associations were as follows: HR = 0.80 (95% CI: 0.71–0.91) and HR = 0.84 (0.77–0.93). There was no significant impact on time to second hip fracture.Conclusions: the introduction and/or expansion of orthogeriatric and FLS models of post-hip fracture care has a beneficial effect on subsequent mortality. No evidence for a reduction in second hip fracture rate was found.

General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms VOLUME 4 ISSUE 28 SEPTEMBER 2016 ISSN 2050 DOI 10.3310/hsdr04280 HEALTH SERVICES AND DELIVERY RESEARCHModels of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and cost-effectiveness study within a region of England Andrew Judge, M Kassim Javaid, José Leal, Samuel Hawley, Sarah Drew, Sally Sheard, Daniel Prieto-Alhambra, Rachael Gooberman-Hill, Janet Lippett, Andrew Farmer, Nigel Arden, Alastair Gray, Michael Goldacre, Antonella Delmestri and Cyrus Cooper Models of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and cost-effectiveness study within a region of England Declared competing interests of authors: Daniel Prieto-Alhambra has received unrestricted research and educational grants from Amgen and Bioibérica S.A. Nigel Arden reports personal fees from Merck Sharp & Dohme (MSD), grants and personal fees from Roche, personal fees from Smith and Nephew, personal fees from Q-Med, personal fees from Nicox, personal fees from Flexion, personal fees from Bioibérica and personal fees from Servier. Cyrus Cooper has received consultancy fees, lecture fees and honoraria from Amgen, GlaxoSmithKline, Alliance for Better Bone Health, Eli Lilly, Pfizer, Novartis, MSD, Servier, Medtronic and Roche. M Kassim Javaid has in the last 5 years received honoraria for travel expenses, speaker fees and/or advisory committees from Lilly UK, Amgen, Servier, MSD, Medtronic, Internis, Consilient Health and Jarrow Formulas. He also serves on the Scientific Committee of the National Osteoporosis Society and International Osteoporosis Foundation. Andrew Judge has received consultancy fees, lecture fees and honoraria from Servier, UK Renal Registry, Oxford Craniofacial Unit, IDIAP Jordi Gol and Freshfields Bruckhaus Deringer, is a member of the Data Safety and Monitoring Board (which involved receipt of fees) from Anthera Pharmaceuticals, Inc., and received consortium research grants from Roche.Published September 2016 DOI: 10.3310/hsdr04280 This report should be referenced as follows:Judge A, Javaid MK, Leal J, Hawley S, Drew S, Sheard S, et al. Models of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and cost-effectiveness study within a region of England. Health Serv Deliv Res 2016;4(28). Health Services and Delivery ResearchISSN 2050-4349 (Print) ISSN 2050-4357 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the repor...

Purpose-To describe the geographic variation in anti-osteoporosis drug therapy prescriptions before and after a hip fracture during 1999-2013 in the UK.Methods-We used primary care data (Clinical Practice Research Datalink) to identify patients with a hip fracture and primary care prescriptions of any anti-osteoporosis drugs prior to the index hip fracture and up to five years after. Geographic variations in prescribing before and after availability of generic oral bisphosphonates were analysed. Multivariable logistic regression models were adjusted for gender, age and body mass index (BMI).Results-13,069 patients (76% female) diagnosed with a hip fracture during 1999-2013 were identified. 11% had any anti-osteoporosis drug prescription in the six months prior to the index hip fracture. In the 0-4 months following a hip fracture 5% of patients were prescribed antiosteoporosis drugs in 1999, increasing to 51% in 2011 to then decrease to 39% in 2013. Author contributionsAS analysed the data and drafted the paper with MKJ. DPA and SH assisted with the analysis and commented on the paper. AD cleaned the data and commented on the paper. JL and CC commented on the paper. AJ and MKJ designed the study, oversaw the analysis and revised the paper. Competing interestsAS, SH and AD have no competing financial interests relevant to the submitted work. DPA, JL, CC, MKJ and AJ received grants from NIHR HS&DR during the conduct of the study. Outside the submitted work, MKJ reports personal fees from Lilly UK, Amgen, Sevier, Merck, Medtronic, Internis, Consilient Health, Stirling Anglia, Mereo Biopharma and Optasia. He serves on the Scientific Committee of the National Osteoporosis Society and International Osteoporosis Foundation; DPA received grants from Bioiberica S.A. and Amgen Spain S.A.; CC received personal fees from Servier, Amgen, Eli Lilly, Merck, Medtronic and Novartis. AJ has received consultancy, lecture fees and honoraria from Servier, UK Renal Registry, Oxford Craniofacial Unit, IDIAP Jordi Gol, Freshfields Bruckhaus Deringer, has held advisory board positions (which involved receipt of fees) from Anthera Pharmaceuticals, INC., and received research sponsorship from ROCHE. Europe PMC Funders GroupAuthor Manuscript Osteoporos Int. Author manuscript; available in PMC 2017 July 01. Europe PMC Funders Author ManuscriptsEurope PMC Funders Author Manuscripts persisted over the 5-year follow-up. If all patients were treated at the rate of the highest performing region, then nationally an additional 3,214 hip fracture patients would be initiated on therapy every year.Conclusions-Significant geographic differences exist in prescribing of anti-osteoporosis drugs after hip fracture despite adjustment for potential confounders. Further work examining differences in health care provision may inform strategies to improve secondary fracture prevention after hip fracture. Mini AbstractFragility fractures of the hip have a major impact on the lives of patients and their families. This study highlights significant geogra...

National Institute of Clinical Excellence guidelines state that cemented stems with an Orthopaedic Data Evaluation Panel (ODEP) rating of > 3B should be used for hemiarthroplasty when treating an intracapsular fracture of the femoral neck. These recommendations are based on studies in which most, if not all stems, did not hold such a rating. This case-control study compared the outcome of hemiarthroplasty using a cemented (Exeter) or uncemented (Corail) femoral stem. These are the two prostheses most commonly used in hip arthroplasty in the UK. Data were obtained from two centres; most patients had undergone hemiarthroplasty using a cemented Exeter stem (n = 292/412). Patients were matched for all factors that have been shown to influence mortality after an intracapsular fracture of the neck of the femur. Outcome measures included: complications, re-operations and mortality rates at two, seven, 30 and 365 days post-operatively. Comparable outcomes for the two stems were seen. There were more intra-operative complications in the uncemented group (13% vs 0%), but the cemented group had a greater mortality in the early post-operative period (n = 6). There was no overall difference in the rate of re-operation (5%) or death (365 days: 26%) between the two groups at any time post-operatively. This study therefore supports the use of both cemented and uncemented stems of proven design, with an ODEP rating of 10A, in patients with an intracapsular fracture of the neck of the femur. Cite this article: Bone Joint J 2015;97-B:94–9.

Understanding avoidable admissions in older people is a pressing issue, with budget restraint, an ageing population and demand for care close to home. To inform local efforts to reduce avoidable admissions in older people we audited a series of acutely ill older people admitted under the local elderly care team. Those admissions that appeared ‘avoidable’ on the ward round were scrutinised in more depth: review of medical notes, patient/carer interview, and primary care provider (GP or community nurse) interview. The information from this process was presented to a GP-consultant panel to judge whether the admission was avoidable. Admissions considered avoidable were classified into one of seven themes. Between 20.6% (27/131) and 32.0% (42/131) of admissions to elderly care were considered potentially avoidable. The findings suggest that avoidable admissions do not just represent a simple failure to manage long-term conditions, but depend on high quality clinical decision making around the time of admission as well as having sufficient capacity in alternative community services.