Textbook process as a composite quality indicator for in-hospital hip fracture care

Abstract

Summary Individual process indicators often do not enable the benchmarking of hospitals and often lack an association with outcomes of care. The composite hip fracture process indicator, textbook process, might be a tool to detect hospital variation and is associated with better outcomes during hospital stay. Purpose The aim of this study was to determine hospital variation in quality of hip fracture care using a composite process indicator (textbook process) and to evaluate at patient level whether fulfilment of the textbook process indicator was associated with better outcomes during hospital stay. Methods Hip fracture patients aged 70 and older operated in five hospitals between 1 January 2018 and 31 December 2018 were included. Textbook process for hip fracture care was defined as follows: (1) assessment of malnutrition (2) surgery within 24 h, (3) orthogeriatric management during admission and (4) operation by an orthopaedic trauma certified surgeon. Hospital variation analysis was done by computing an observed/expected ratio (O/E ratio) for textbook process at hospital level. The expected ratios were derived from a multivariable logistic regression analysis including all relevant case-mix variables. The association between textbook process compliance and in-hospital complications and prolonged hospital stay was determined at patient level in a multivariable logistic regression model, with correction for patient, treatment and hospital characteristics. In-hospital complications were anaemia, delirium, pneumonia, urinary tract infection, in-hospital fall, heart failure, renal insufficiency, pulmonary embolism, wound infection and pressure ulcer. Results Of the 1371 included patients, 753 (55%) received care according to textbook process. At hospital level, the textbook compliance rates ranged from 38 to 76%. At patient level, textbook process compliance was significantly associated with fewer complications (38% versus 46%) (OR 0.66, 95% CI 0.52–0.84), but not with hospital stay (median length of hospital stay was 5 days in both groups) (OR 1.01, 95% CI 0.78–1.30). Conclusion The textbook process indicator for hip fracture care might be a tool to detect hospital variation. At patient level, this quality indicator is associated with fewer complications during hospital stay.

Development and validation of automated electronic health record data reuse for a multidisciplinary quality dashboard

“…In the future, other functionalities can be developed, such as a signaling function that notifies healthcare providers when a patient is in danger of failing to adhere to process indicators, which is known as a textbook process. 27 Alternatively, a provider-specific dashboard could be developed that shows the current status of their patients, and where they currently are in their patient journey. Moreover, further steps should be taken to accomplish digital healthcare information exchange with other organizations, such as national quality registries or other healthcare centers.…”

Poor prognosis and risk factors of nonoperative treatment hip fracture patients with end-stage renal disease

“…[2] In Sadat-Ali M. et al study, [3] the 1-year mortality rate associated with hip fractures was 26.98%, which is similar to the results of previous studies. [4] Complications such as pulmonary infection, [5] pressure ulcers, delirium, urinary tract infection, renal insufficiency, deep vein thrombosis, or pulmonary embolism following hip fractures are common, [6] and they directly or indirectly endanger the lives of patients. The preferred treatment for hip fractures is surgical treatment, including hip arthroplasty [7] and internal fixation.…”