Does achieving the ‘Best Practice Tariff’ criteria for fractured neck of femur patients improve one year outcomes?

Whitaker, Samuel R.; Nisar, Sohail; Scally, Andrew J.; Radcliffe, Graham

doi:10.1016/j.injury.2019.06.007

Cited by 20 publications

(13 citation statements)

References 16 publications

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“…Survival analysis also found a significant long-term survival benefit for BPT conforming admissions. Whitaker et al 34 similarly found that 1-year survival was significantly better in BPT conforming admissions. Metcalfe et al 35 compared admissions in England and Scotland following the introduction of the BPT (which only applies to England) and found that there was a greater reduction in mortality, readmissions and length of hospital stay during the BPT period in England than in Scotland.…”

Section: Discussionmentioning

confidence: 93%

Does pay-for-performance improve patient outcomes in acute exacerbation of COPD admissions?

Stone

Adamson

Hurst

et al. 2021

Thorax

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BackgroundThe COPD Best Practice Tariff (BPT) is a pay-for-performance scheme in England that incentivises review by a respiratory specialist within 24 hours of admission and completion of a list of key care components prior to discharge, known as a discharge bundle, for patients admitted with acute exacerbation of COPD (AECOPD). We investigated whether the two components of the COPD BPT were associated with lower 30-day mortality and readmission in people discharged following AECOPD.MethodsLongitudinal study of national audit data containing details of AECOPD admissions in England and Wales between 01 February 2017 and 13 September 2017. Data were linked with national admissions and mortality data. Mixed-effects logistic regression, using a random intercept for hospital to adjust for clustering of patients, was used to determine the relationship between the COPD BPT criteria (combined and separately) and 30-day mortality and readmission. Models were adjusted for age, sex, socioeconomic status, length of stay, smoking status, Charlson comorbidity index, mental illness and requirement for oxygen or noninvasive ventilation during admission.Results28 345 patients discharged from hospital following AECOPD were included. 37% of admissions conformed to the two COPD BPT criteria. No relationship was observed between BPT conforming admissions and 30-day mortality (OR: 1.09 (95% CI 0.92 to 1.29)) or readmissions (OR: 0.96 (95% CI 0.90 to 1.02)). No relationship was observed between either of the individual COPD BPT components and 30-day mortality or readmissions. However, a specialist review at any time during admission was associated with lower inpatient mortality (OR: 0.69 (95% CI 0.58 to 0.81)).ConclusionCompletion of the combined COPD BPT criteria does not appear associated with a reduction in 30-day mortality or readmission. However, specialist review was associated with reduced inpatient mortality. While it is difficult to argue that discharge bundles do not improve care, this analysis questions whether the pay-for-performance model improves mortality or readmissions.

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Section: Discussionmentioning

confidence: 93%

Does pay-for-performance improve patient outcomes in acute exacerbation of COPD admissions?

Stone

Adamson

Hurst

et al. 2021

Thorax

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“…32 The introduction of BPT has improved 30-day and one-year mortality in hip fracture patients. 33,34 Given the similar age and comorbidity profile, patients sustaining femoral PPF’s may benefit from similar multidisciplinary care, as encouraged by the expansion of BPT. However, as shown by the wide range of ages observed in this study, not all PPF patients are elderly, and some younger patients are likely to have different rehabilitation requirements.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and characteristics of femoral periprosthetic fractures

2022

The Bone & Joint Journal

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Aims The aim of this study was to describe the demographic details of patients who sustain a femoral periprosthetic fracture (PPF), the epidemiology of PPFs, PPF characteristics, and the predictors of PPF types in the UK population. Methods This is a multicentre retrospective cohort study including adult patients presenting to hospital with a new PPF between 1 January 2018 and 31 December 2018. Data collected included: patient characteristics, comorbidities, anticoagulant use, social circumstances, level of mobility, fracture characteristics, Unified Classification System (UCS) type, and details of the original implant. Descriptive analysis by fracture location was performed, and predictors of PPF type were assessed using mixed-effects logistic regression models. Results In total, 720 femoral PPFs from 27 NHS sites were included. PPF patients were typically elderly (mean 79.9 years (SD 10.6)), female (n = 455; 63.2%), had at least one comorbidity (n = 670; 93.1%), and were reliant on walking aids or bed-/chair-bound prior to admission (n = 419; 61.7%). The study population included 539 (74.9%) hip PPFs, 151 (21.0%) knee PPFs, and 30 (4.2%) dividing type PPFs. For hip (n = 407; 75.5%) and knee (n = 88; 58.3%) arthroplasty UCS B type fractures were most common. Overall, 556 (86.2%) were treated in the presenting hospital and 89 (13.8%) required transfer for treatment. Female sex was the only significant predictor of fracture type (A/B1/C type versus B2/B3) for femoral hip PPFs (odds ratio 0.61 (95% confidence interval 0.41 to 0.91); p = 0.014). Sex, residence type, primary versus revision implant PPF, implant fixation, and time between arthroplasty and PPF were not found to predict fracture type for hip PPFs. Conclusion This multicentre analysis describes patient and injury factors for patients presenting with femoral PPFs to centres across the UK. These patients are generally elderly and frail, comparable to those sustaining a hip fracture. These data can be useful in planning future services and clinical trials. Cite this article: Bone Joint J 2022;104-B(8):987–996 .

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“…The introduction of BPT came from the principles of ‘Equity and Excellence: liberating the NHS’ white paper[ 22 ]. Loss of BPT results in financial loss of monetary incentives and poor patients’ outcomes.…”

Section: Discussionmentioning

confidence: 99%

Achieving the hip fracture Best Practise Tariff during the COVID-19 pandemic

Ali¹,

Fadulelmola²,

Urwin³

et al. 2022

JFSF

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Objectives: Achieving the hip fracture best practice tariff is associated with decreased mortality rates. The aim of this study is to evaluate the impact of Covid-19 pandemic on achieving Best Practice Tariff. Methods: We retrospectively reviewed all adult hip fractures admitted to our unit between March and June 2020. Patient's characteristics, place of residence, delirium assessment, and mobility status were recorded. All the Best practice Tariff criteria have been analysed. Covid-19 was diagnosed using reverse transcriptase polymerase chain reaction. Results: 178 patients with a mean age of 82.8 years presented with hip fractures during the study period. 18 patients (10.1%) tested positive for COVID-19. 44.4% failed to achieve the BPT from the COVID-19 positive group and 22.5% from the negative group. Conclusion: Based on this study, hip fractures associated with Covid-19 infection are more likely to fail the BPT and have higher 30-day mortality rates compare to the COVID-19 negative patients.

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Does achieving the ‘Best Practice Tariff’ criteria for fractured neck of femur patients improve one year outcomes?

Cited by 20 publications

References 16 publications

Does pay-for-performance improve patient outcomes in acute exacerbation of COPD admissions?

Does pay-for-performance improve patient outcomes in acute exacerbation of COPD admissions?

Epidemiology and characteristics of femoral periprosthetic fractures

Achieving the hip fracture Best Practise Tariff during the COVID-19 pandemic

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