Improving the care of patients with a hip fracture: a quality improvement report

Hawkes, David; Baxter, Jonathan R.; Bailey, Claire; Holland, G; Ruddlesdin, Jennifer; Wall, Alun; Wykes, P.

doi:10.1136/bmjqs-2014-003700

Cited by 21 publications

(20 citation statements)

References 18 publications

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“…2,42 The incidence of hip fractures in the UK is rising annually and is currently estimated at 10.2 per 10 000 per year. 43 The cost to the hospital services of hip fracture are substantial, and have been estimated to be £1,131 million in the year of the fracture. 44 Thus the impact of policies such as BPT are of interest to policymakers.…”

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confidence: 99%

A comparison of methods for health policy evaluation with controlled pre‐post designs

O’Neill

Kreif

Sutton

et al. 2020

Health Services Research

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Objective To compare interactive fixed effects (IFE) and generalized synthetic control (GSC) methods to methods prevalent in health policy evaluation and re‐evaluate the impact of the hip fracture best practice tariffs introduced for hospitals in England in 2010. Data Sources Simulations and Hospital Episode Statistics. Study Design Best practice tariffs aimed to incentivize providers to deliver care in line with guidelines. Under the scheme, 62 providers received an additional payment for each hip fracture admission, while 49 providers did not. We estimate the impact using difference‐in‐differences (DiD), synthetic control (SC), IFE, and GSC methods. We contrast the estimation methods' performance in a Monte Carlo simulation study. Principal Findings Unlike DiD, SC, and IFE methods, the GSC method provided reliable estimates across a range of simulation scenarios and was preferred for this case study. The introduction of best practice tariffs led to a 5.9 (confidence interval: 2.0 to 9.9) percentage point increase in the proportion of patients having surgery within 48 hours and a statistically insignificant 0.6 (confidence interval: −1.4 to 0.4) percentage point reduction in 30‐day mortality. Conclusions The GSC approach is an attractive method for health policy evaluation. We cannot be confident that best practice tariffs were effective.

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confidence: 99%

A comparison of methods for health policy evaluation with controlled pre‐post designs

O’Neill

Kreif

Sutton

et al. 2020

Health Services Research

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“…In the USA, ~300,000 hip fractures occur annually, and this number is expected to rise with the growth of elderly populations (4). Furthermore, mortality in the elderly may reach 10% at 1 month, 20% at 4 months and 30% at 1 year following hip fracture (5).…”

Section: Introductionmentioning

confidence: 99%

Early surgery increases mitochondrial DNA release and lung injury in a model of elderly hip fracture and chronic obstructive pulmonary disease

Zhang

Wang

et al. 2017

Exp Ther Med

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Abstract. Hip fractures are one of the most common injuries in elderly individuals and are associated with a high incidence of complications and mortality. Clinical guidelines recommend early reparative surgery within 24-48 h from hospital admission; however, it is currently unknown whether this principle of early surgery is applicable for patients with hip fracture and chronic obstructive pulmonary disease (COPD). To investigate the systemic inflammatory response and lung injury as a result early surgery in elderly patients with hip fracture and COPD, a COPD model was created, by daily exposure to cigarette smoke, and evaluated. Rats (5 months of age) were exposed to cigarette smoking for 37 weeks to create a COPD group.

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“…Continuous monitoring of the quality of healthcare has been implemented in many European countries 14 including Finland (PERFormance, Effectiveness and Cost of Treatment episodes), 47 Sweden (Rikshöft), 48 the United Kingdom (UK) (the National Hip Fracture Database), 13,49 Scotland (the Scottish Hip Fracture Audit), 50 Italy (Regional Outcome Evaluation Program in the Lazio region 51 and Gruppo Italiano di Ortogeriatria), 52 Norway (The Norwegian Hip Fracture Registry), 53 Spain (National Hip Fracture Registry), 54 Ireland (Irish Hip Fracture database), 55 Nederlands (Dutch National Hip Fracture Audit), 56 Germany (Alterstrauma register), 57 and Denmark (DMHFR). However, the majority of these registries 47,50,51,[53][54][55] mainly monitor outcome performance measures, eg, mortality and readmissions at the hospital level, and lack continuous monitoring of process performance measures.…”

Section: Comparison With Other Hip Fracture Registriesmentioning

confidence: 99%

<p>The Danish Multidisciplinary Hip Fracture Registry 13-Year Results from a Population-Based Cohort of Hip Fracture Patients</p>

Kristensen¹,

Röck²,

Christensen³

et al. 2020

CLEP

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Aim of the Registry: The aim of the Danish Multidisciplinary Hip Fracture Registry (DMHFR) is to collect data on processes of treatment, nursing care and rehabilitation as well as outcomes for patients with hip fracture in Denmark, and thereby monitor and improve the quality. Study Population: Hip fracture patients at age 65 or older that have undergone surgery with arthroplasty or internal fixation since 2004. Main Variables: DMHFR collects quality indicators and descriptive variables. Quality indicators include eight process performance measures within treatment, nursing care and rehabilitation, reflecting recommendations from the national clinical guideline for hip fracture patients, and three outcome measures including survival within 30-days, unplanned acute readmission within 30 days and reoperation within 2 years. Descriptive variables include a number of patient-and surgery-related characteristics. All data are collected prospectively. Results: By the end of 2018, the DMHFR included 86,438 hip fracture patients. Since 2006, all hospital departments in Denmark, treating patients with hip fracture, have reported improvement in quality of care and improvement in survival, and reoperation over time as well as high completeness of variables registration. Conclusion: The DMHFR is a well-established nationwide clinical registry, which plays a key role for monitoring and improving hip fracture care in Denmark. The registry can further be linked to a range of other nationwide registries in order to answer a number of relevant clinical research questions.

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Improving the care of patients with a hip fracture: a quality improvement report

Cited by 21 publications

References 18 publications

A comparison of methods for health policy evaluation with controlled pre‐post designs

A comparison of methods for health policy evaluation with controlled pre‐post designs

Early surgery increases mitochondrial DNA release and lung injury in a model of elderly hip fracture and chronic obstructive pulmonary disease

<p>The Danish Multidisciplinary Hip Fracture Registry 13-Year Results from a Population-Based Cohort of Hip Fracture Patients</p>

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