Learning From England's Best Practice Tariff

Zogg, Cheryl K.; Metcalfe, David; Judge, Andrew; Perry, Daniel C.; Costa, Matthew L.; Gabbe, Belinda; Schoenfeld, Andrew J.; Davis, Kimberly A.; Cooper, Zara; Lichtman, Judith H.

doi:10.1097/sla.0000000000004305

Cited by 10 publications

(6 citation statements)

References 34 publications

(65 reference statements)

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“…Our study cohort was similar to other large UK hip fracture cohorts in terms of sociodemographic, clinical and treatment-based characteristics 17 47 48. Similar trends in hip fracture surgery towards more conservative management, reductions in length of stay and COVID-19 infection rates were observed by others 6 49 50.…”

Section: Discussionsupporting

confidence: 84%

Indirect effect of the COVID-19 pandemic on hospital mortality in patients with hip fracture: a competing risk survival analysis using linked administrative data

et al. 2022

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BackgroundHip fracture is a leading cause of disability and mortality among older people. During the COVID-19 pandemic, orthopaedic care pathways in the National Health Service in England were restructured to manage pressures on hospital capacity. We examined the indirect consequences of the pandemic for hospital mortality among older patients with hip fracture, admitted from care homes or the community.MethodsRetrospective analysis of linked care home and hospital inpatient data for patients with hip fracture aged 65 years and over admitted to hospitals in England during the first year of the pandemic (1 March 2020 to 28 February 2021) or during the previous year. We performed survival analysis, adjusting for case mix and COVID-19 infection, and considered live discharge as a competing risk. We present cause-specific hazard ratios (HRCS) for the effect of admission year on hospital mortality risk.ResultsDuring the first year of the pandemic, there were 55 648 hip fracture admissions: a 5.2% decrease on the previous year. 9.5% of patients had confirmed or suspected COVID-19. Hospital stays were substantially shorter (p<0.05), and there was a higher daily chance of discharge (HRCS 1.40, 95% CI 1.38 to 1.41). Overall hip fracture inpatient mortality increased (7.2% in 2020/2021 vs 6.4% in 2019/2020), but patients without concomitant COVID-19 infection had lower mortality rates compared with the year before (5.3%). Admission during the pandemic was associated with a 11% increase in the daily risk of hospital death for patients with hip fracture (HRCS 1.11, 95% CI 1.05 to 1.16).ConclusionsAlthough COVID-19 infections led to increases in hospital mortality, overall hospital mortality risk for older patients with hip fracture remained largely stable during the first year of the pandemic.

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Section: Discussionsupporting

confidence: 84%

Indirect effect of the COVID-19 pandemic on hospital mortality in patients with hip fracture: a competing risk survival analysis using linked administrative data

et al. 2022

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“…Preoperative medical assessment, unrestricted weight bearing, postoperative day 1 mobilization, and delay to surgery have shown little improvement [11] . With publicly available performance outcomes, [26] it is theorized that services will be obliged to access expert knowledge to improve standards of care in the absence of payment-based performance incentives [27] …”

Section: Discussionmentioning

confidence: 99%

“…[11] With publicly available performance outcomes, [26] it is theorized that services will be obliged to access expert knowledge to improve standards of care in the absence of payment-based performance incentives. [27] Despite efforts from expert groups and national osteoporosis plans, as of 2019 there were only 32 FLSs established nationally. [3] Locally-based FLS models have demonstrated reductions of major secondary fractures by 40% over 3-years.…”

Section: Barriersmentioning

confidence: 99%

Fragility Fracture Systems: International Perspectives - Asia & Australia

Tarrant

Kim

Matsushita

et al. 2022

OTA International: The Open Access Journal of Orthopaedic Trauma

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Background: The incidence and burden of fragility fractures have reached the level where comprehensive systematic care is warranted to optimize the care of these patients. Hip fractures are the most frequently lethal and independence level changing fragility fractures, responsible for 30-day mortality comparable to high-energy trauma patients with injury severity scores over 12. It is a reasonable expectation that countries have a hip fracture treating system of care in place for this high-risk population. This review explores the systems of care from the Asia-Pacific Perspective.Methods: From the International Orthopaedic Trauma Association's member societies, nations from the Asia-Pacific Region were requested to contribute with an overview of their fragility fracture management systems. The content or the review was standardized by a template of headings, which each country endeavored to cover.Results: Australia, Japan, and South Korea contributed voluntarily from the 5 member countries of the region. Each country has made considerable efforts and achievements with diverse approaches to standardize and improve the care of fragility fractures, particularly hip fractures. Beyond the individual nations' efforts there is also an existing Asia-Pacific Collaborative. The data collection and in some counties the existence of a registry is promising; funding and recognition of the problem among competing health care budget priorities are common.Conclusions: Our review covers some of the countries with strongest economy and highest health care standards. The lack of a universal robust system for hip fracture care is apparent. The data collection from registry initiations is expected to drive system development further in these countries and hopefully fast track the development in other countries within the most populous geographical region of the Earth.

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“…Furthermore, there are currently national FLS registries at various stages of development in Australia and New Zealand ( 391 , 392 ), Ireland ( 393 ), the UK ( 394 ), and USA ( 395 ). Several “real-world” evidence from the UK National Hip Fracture Database and Best Practice Tariff for hip fracture care have provided valuable insights ( 396 – 398 ). In Italy, the “real-world” monitoring changes and assessing impact of the new guidelines will be made possible by the “Italian Fragility Fracture Observatory,” a structure recently founded for bridging the gap between health institution and academy in generating knowledge ( 399 ) in the field of fragility fractures.…”

Section: Perspectivesmentioning

confidence: 99%

Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021

et al. 2023

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BackgroundFragility fractures are a major public health concern owing to their worrying and growing burden and their onerous burden upon health systems. There is now a substantial body of evidence that individuals who have already suffered a fragility fracture are at a greater risk for further fractures, thus suggesting the potential for secondary prevention in this field.PurposeThis guideline aims to provide evidence-based recommendations for recognizing, stratifying the risk, treating, and managing patients with fragility fracture. This is a summary version of the full Italian guideline.MethodsThe Italian Fragility Fracture Team appointed by the Italian National Health Institute was employed from January 2020 to February 2021 to (i) identify previously published systematic reviews and guidelines on the field, (ii) formulate relevant clinical questions, (iii) systematically review literature and summarize evidence, (iv) draft the Evidence to Decision Framework, and (v) formulate recommendations.ResultsOverall, 351 original papers were included in our systematic review to answer six clinical questions. Recommendations were categorized into issues concerning (i) frailty recognition as the cause of bone fracture, (ii) (re)fracture risk assessment, for prioritizing interventions, and (iii) treatment and management of patients experiencing fragility fractures. Six recommendations were overall developed, of which one, four, and one were of high, moderate, and low quality, respectively.ConclusionsThe current guidelines provide guidance to support individualized management of patients experiencing non-traumatic bone fracture to benefit from secondary prevention of (re)fracture. Although our recommendations are based on the best available evidence, questionable quality evidence is still available for some relevant clinical questions, so future research has the potential to reduce uncertainty about the effects of intervention and the reasons for doing so at a reasonable cost.

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Learning From England's Best Practice Tariff

Cited by 10 publications

References 34 publications

Indirect effect of the COVID-19 pandemic on hospital mortality in patients with hip fracture: a competing risk survival analysis using linked administrative data

Indirect effect of the COVID-19 pandemic on hospital mortality in patients with hip fracture: a competing risk survival analysis using linked administrative data

Fragility Fracture Systems: International Perspectives - Asia & Australia

Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021

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