Implementing the National Hip Fracture Database: An audit of care

Patel, Nirav K.; Sarraf, Khaled M; Joseph, Sarah; Lee, Chooi; Middleton, Fiona R.

doi:10.1016/j.injury.2013.04.012

Cited by 67 publications

(69 citation statements)

References 43 publications

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“…The UK has successfully improved outcomes for hip fractures through the Best Practice Tariff, introduced in April 2010, providing reimbursements on best practices [15]. This includes surgery within 36 h of admission.…”

Section: Quality/risk Stratificationmentioning

confidence: 99%

Pay-for-performance in orthopedics: how we got here and where we are going

Goldman

Kates

2017

Curr Rev Musculoskelet Med

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Purpose of the review Recent health laws have shifted from the traditional fee-for-service model toward a pay-forperformance model. In this changing climate, it is imperative that a provider understands these changes and recognizes the importance of health services research on medicine. Recent findings Increasing the value of care by improving quality and decreasing cost has been the focus of several projects. Preventing complications may be an effective way to increase value. Summary Patient risk stratification is a modifiable variable that will allow for improved patient selection. This in turn may reduce adverse events, thereby lessening the economic burden of complications, increased length of stay, and hospital readmission. Providers must partner with their hospitals to align their goals and maximize quality and efficiency in order to decrease costs.

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Section: Quality/risk Stratificationmentioning

confidence: 99%

Pay-for-performance in orthopedics: how we got here and where we are going

Goldman

Kates

2017

Curr Rev Musculoskelet Med

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“…This was followed by the development of the National Hip Fracture Database in the UK to audit compliance with these standards as well as national 'Best Practice Tariff' financial incentive. These initiatives were associated with improvements in outcomes including a reduction in mortality rates [10,11] ( Fig. 1).…”

Section: Introduction To the History Of Orthogeriatricsmentioning

confidence: 99%

Orthogeriatrics in the management of frail older patients with a fragility fracture

Sabharwal¹,

Wilson

2015

Osteoporos Int

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This review article examines the role of orthogeriatric management for frail older patients with a fragility fracture. The history of orthogeriatrics and its application in clinical practice around the world is reported, and an evidence-based evaluation for the effect of orthogeriatric management on patient morbidity and mortality is also provided. It has been more than 50 years since the role of the geriatrician in the management of patients with a hip fracture was first described. The evidence that supports an orthogeriatric model of care has grown exponentially over the last decade. This evidence base is primarily related to hip fractures and demonstrates reduced morbidity and mortality rates amongst patients managed with a recognised model of orthogeriatric care. The societal and economic burden of hip fracture has led to health economic evaluations within this field, many of which have concluded that orthogeriatric management results in cost-effective clinical practice. Based on existing clinical and economic research, national clinical practice guidelines have been developed in several countries which recommend orthogeriatric participation in the management of older patients with a hip fracture. Compliance with such guidance has already demonstrated improved patient outcomes. Although the pathogenesis and prognosis of other types of fragility fracture may be as poor, there is a dearth of clinical research that evaluates the effect of orthogeriatric management on such injuries. Looking to the future, orthogeriatric management is likely to become more widespread, and the robust collection and reporting of patient outcomes from national registries will provide a greater understanding of the impact of orthogeriatric models in the care of all frail older patients with any type of fragility fracture.

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“…There is clear evidence of improved care in the population with hip fracture due to units meeting the hip fracture BPT criteria with significant benefit in patient outcomes. 9,10 In order to achieve the extra financial benefit (£1335 per patient) of the top-up payment that is additional to the base tariff received by the hospital for a hip fracture episode, all domains of the BPT (including operation within 36 hours) for hip fractures must be met. The data for each case are reconciled through the National Hip Fracture Database (NHFD).…”

Section: Introductionmentioning

confidence: 99%

“Tiers of Delay”

Eardley

MacLeod

Freeman

et al. 2014

Geriatr Orthop Surg Rehabil

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Anticoagulation reversal is a common cause of operative delay. We sought to establish for the first time the impact this has on best practice tariff (BPT) for patients with hip fracture admitted on warfarin. All patients with hip fracture treated operatively over a 32-month period were reviewed. Basic demographics, time to theater, length of stay, and mortality were recorded for all patients. Independent samples t-tests were used to identify statistically significant differences between patients on warfarin and those not taking the drug. A total of 83 patients were admitted anticoagulated with a mean international normalized ratio of 2.65 and a median time to theater of 49.7 hours. Of these patients, 79% breached BPT, incurring significant financial loss. In the control group, 908 patients took a median 24.5 hours, a 28% breach of BPT (P < .01). Length of stay, Nottingham Hip Fracture Score, and predicted 30-day mortality were similar for both the groups. As well as affecting clinical outcome following hip fracture, delay due to anticoagulation causes considerable loss of BPT. Potential loss of revenue due to delays over the study period was £80 000, inspiring the establishment of an ''early trigger'' anticoagulation protocol. Although it is accepted that there are limitations to this work, it should raise awareness of the real impact of warfarin on patients with hip fracture both in terms of outcome and for the first time, loss of potential revenue.

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Implementing the National Hip Fracture Database: An audit of care

Cited by 67 publications

References 43 publications

Pay-for-performance in orthopedics: how we got here and where we are going

Pay-for-performance in orthopedics: how we got here and where we are going

Orthogeriatrics in the management of frail older patients with a fragility fracture

“Tiers of Delay”

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