Pay for performance and hip fracture outcomes

Metcalfe, David; Zogg, Cheryl K.; Judge, Andrew; Perry, Daniel C.; Gabbe, Belinda; Willett, Keith; Costa, Matthew L.

doi:10.1302/0301-620x.101b8.bjj-2019-0173.r1

Cited by 92 publications

(57 citation statements)

References 30 publications

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“…Furthermore, an absolute mortality risk of 14.9% was observed within 30 days in-hospital in Canadians admitted to hospital with any stroke in 2012 (25% aged 70–79, 38% aged ≥80) [ 30 ]. Considering that significant reductions in mortality risks associated with cardiovascular events have been reported over the past few decades [ 30 – 32 ], this data demonstrating a clear association between fragility fracture and mortality risk further highlights the need for effective measures to improve osteoporosis management and prevention of fragility fractures in older adults [ 11 – 13 , 17 – 19 , 21 – 23 ].…”

Section: Discussionmentioning

confidence: 97%

Mortality in older adults following a fragility fracture: real-world retrospective matched-cohort study in Ontario

Brown

Adachi

Schemitsch

et al. 2021

BMC Musculoskelet Disord

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Background Recent studies are lacking reports on mortality after non-hip fractures in adults aged > 65. Methods This retrospective, matched-cohort study used de-identified health services data from the publicly funded healthcare system in Ontario, Canada, contained in the ICES Data Repository. Patients aged 66 years and older with an index fragility fracture occurring at any osteoporotic site between 2011 and 2015 were identified from acute hospital admissions, emergency and ambulatory care using International Classification of Diseases (ICD)-10 codes and data were analyzed until 2017. Thus, follow-up ranged from 2 years to 6 years. Patients were excluded if they presented with an index fracture occurring at a non-osteoporotic fracture site, their index fracture was associated with a trauma code, or they experienced a previous fracture within 5 years prior to their index fracture. This fracture cohort was matched 1:1 to controls within a non-fracture cohort by date, sex, age, geography and comorbidities. All-cause mortality risk was assessed. Results The survival probability for up to 6 years post-fracture was significantly reduced for the fracture cohort vs matched non-fracture controls (p < 0.0001; n = 101,773 per cohort), with the sharpest decline occurring within the first-year post-fracture. Crude relative risk of mortality (95% confidence interval) within 1-year post-fracture was 2.47 (2.38–2.56) in women and 3.22 (3.06–3.40) in men. In the fracture vs non-fracture cohort, the absolute mortality risk within one year after a fragility fracture occurring at any site was 12.5% vs 5.1% in women and 19.5% vs 6.0% in men. The absolute mortality risk within one year after a fragility fracture occurring at a non-hip vs hip site was 9.4% vs 21.5% in women and 14.4% vs 32.3% in men. Conclusions In this real-world cohort aged > 65 years, a fragility fracture occurring at any site was associated with reduced survival for up to 6 years post-fracture. The greatest reduction in survival occurred within the first-year post-fracture, where mortality risk more than doubled and deaths were observed in 1 in 11 women and 1 in 7 men following a non-hip fracture and in 1 in 5 women and 1 in 3 men following a hip fracture.

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Section: Discussionmentioning

confidence: 97%

Mortality in older adults following a fragility fracture: real-world retrospective matched-cohort study in Ontario

Brown

Adachi

Schemitsch

et al. 2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

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“…These criteria form the foundations of the best care evidence-based practice tariffs. These guidelines also offer healthcare providers financial incentives for delivering optimal care which is proven to improve neck of femur fracture outcomes [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Increased perioperative mortality for femoral neck fractures in patients with coronavirus disease 2019 (COVID-19): experience from the United Kingdom during the first wave of the pandemic

et al. 2021

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Background The coronavirus disease 19 (COVID-19) pandemic has presented modern healthcare with an unprecedented challenge. At the peak of the pandemic, trauma and orthopaedic services at our institutions undertook internal restructuring, diverting resources to frontline medical care. Consequently, we sought to assess the impact on the elderly and comorbid patients presenting with femoral neck fractures, with a particular focus on 30-day mortality, length of stay, multidisciplinary team involvement and departmental structuring. Method A retrospective analysis of patients presenting with femoral neck fractures at three separate West London NHS Trusts was undertaken between March 11, 2020, to April 30, 2020. Length of stay, 30-day mortality and adherence to parameters constituting the best care evidence-based practice tariffs were compared between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive and negative patients. A similar comparison was also conducted between our cohort and the equivalent period in 2018 using data from the National Hip Fracture Database. Results A total of 68 patients presenting with femoral neck fractures were identified, mean age 81 (range 38–98), 73% female. There were 10 confirmed/suspected cases of COVID-19 on admission and a further seven confirmed as inpatients. The 30-day mortality within our cohort was 11.76% compared to 6% nationally in 2018 (p = 0.045). Orthogeriatric reviews occurred within 72 h in 71% of cases compared to 88% in the equivalent 2018 period. Within the cohort, mean length of stay was 17.13 days (SD 5.6, range 8-27 days) for SARS-CoV-2 positive patients compared to 10 days (SD 8.7, range 1–53 days) for negative patients (p < 0.05). Thirty-two patients (47%) required increased packages of care on discharge or rehabilitation. Conclusions The increase in 30-day mortality for SARS-CoV-2 positive patients presenting with femoral neck fractures is multifactorial, resulting from a combination of the direct effects of COVID-19 pneumonia as well as changes to the delivery of orthopaedic services. The provision of multidisciplinary care was directly affected by staff redeployment, particularly reorganisation of orthogeriatric services and lack of continuity of ward based clinical care. Our experiences have re-directed efforts towards the management of theatre teams, patient services and staffing, should we be faced with either a resurgence of COVID-19 or a future pandemic.

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“…There are similarities and differences between the COPD audit programme and other UK national audits. The UK National Hip Fracture Database recently reported that pay-for-performance was associated with reduced mortality, shorter length of stay and fewer readmissions by comparing performance in England (where care quality was financially incentivised) to Scotland (where it was not) over a period of 10 years [ 31 ]. Other UK national databases such as the Myocardial Ischaemia National Audit Project (MINAP) have demonstrated optimal use of guidelines to be associated with better outcomes after myocardial infarction [ 32 ], suggesting potential gains in COPD can be large if adherence to guidelines could be improved.…”

Section: Discussionmentioning

confidence: 99%

National clinical audit for hospitalised exacerbations of COPD

et al. 2020

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IntroductionExacerbations of COPD requiring hospital admission are burdensome to patients and health services. Audit enables benchmarking performance between units and against national standards, and supports quality improvement. We summarise 23 years of UK audit for hospitalised COPD exacerbations to better understand which features of audit design have had most impact.MethodPilot audits were performed in 1997 and 2001, with national cross-sectional audits in 2003, 2008 and 2014. Continuous audit commenced in 2017. Overall, 96% of eligible units took part in cross-sectional audit, 86% in the most recent round of continuous audit. We synthesised data from eight rounds of national COPD audit.ResultsClinical outcomes were observed to change at the same time as changes in delivery of care: length of stay halved from 8 to 4 days between 1997 and 2014, alongside wider availability of integrated care. Process indicators did not generally improve with sequential cross-sectional audit. Under continuous audit with quality improvement support, process indicators linked to financial incentives (early specialist review (55–66%) and provision of a discharge bundle (53–74%)) improved more rapidly than those not linked (availability of spirometry (40–46%) and timely noninvasive ventilation (21–24%)).ConclusionCareful piloting and engagement can result in successful roll-out of cross-sectional national audit in a high-burden disease. Audit outcome measures and process indicators may be affected by changes in care pathways. Sequential cross-sectional national audit alone was not generally accompanied by improvements in care. However, improvements in process indicators were seen when continuous audit was combined with quality improvement support and, in particular, financial incentives.

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Pay for performance and hip fracture outcomes

Cited by 92 publications

References 30 publications

Mortality in older adults following a fragility fracture: real-world retrospective matched-cohort study in Ontario

Mortality in older adults following a fragility fracture: real-world retrospective matched-cohort study in Ontario

Increased perioperative mortality for femoral neck fractures in patients with coronavirus disease 2019 (COVID-19): experience from the United Kingdom during the first wave of the pandemic

National clinical audit for hospitalised exacerbations of COPD

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