The Dutch Hip Fracture Audit: evaluation of the quality of multidisciplinary hip fracture care in the Netherlands

Abstract

Summary The nationwide Dutch Hip Fracture Audit (DHFA) is initiated to improve the quality of hip fracture care by providing insight into the actual quality of hip fracture care in daily practice. The baseline results demonstrate variance in practice, providing potential starting points to improve the quality of care. Purpose The aim of this study is to describe the development and initiation of the DHFA. The secondary aim is to describe the hip fracture care in the Netherlands at the start of the audit and to assess whether there are differences in processes at baseline between hospitals. Methods Eighty-one hospitals were asked to register their consecutive hip fracture patients since April 2016. In 2017, the first full calendar year, the case ascertainment was determined at audit level. Three quality indicators were used to describe and assess the care process at audit and hospital level: the proportion of completed variables at discharge and at 3 months after operation, time to surgery and orthogeriatric management. Results Sixty (74%) hospitals documented 14,274 patients in the DHFA by December 2017. In 2017, the case ascertainment was 58% and the average proportion of completed variables was 77%: 91% at discharge and 30% at 3 months. The median time to operation was 18 h (IQR 7–23) for American Society of Anesthesiologists score (ASA) 1–2 patients and 21 h (IQR 13–27) for ASA 3–4 patients. Of patients aged 70 years and older, 78% received orthogeriatric management. At hospital level, all three indicators showed significant practice variance. Conclusion Not all hospitals participate in the DHFA, and the data gathering process needs to be further optimized. However, the baseline results demonstrate an apparent variance in hip fracture practice between hospitals in the Netherlands, providing potential starting points to improve the quality of hip fracture care.

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

“…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.…”

Validation of the Fracture Mobility Score against the Parker Mobility Score in hip fracture patients

“…As part of the DHFA, the Fracture Mobility Score has to be collected for every patient at admission, at hospital discharge and three months after operation [1] . For registry purposes, the category 'unknown' was added to the five original categories of the Fracture Mobility Score.…”

“…In large clinical hip fracture audits, ongoing efforts are being made to maintain the registration load as low as possible [1] . In this respect, the Fracture Mobility Score seems to be a preferred tool over both the Parker Mobility Score and the Cumulated Ambulation Score.…”

“…In the Netherlands, all approximately 18,500 hip fracture patients need to be entered into the DHFA and their mobility needs to be scored on three occasions (at admission, at hospital discharge and three months after operation). This results in a difference of 111,0 0 0 questions (55,50 0 for the Parker Mobility Score versus 166,500 for the Fracture Mobility Score) to be answered [1] . In general, the lower the registration load, the higher the chance of data completeness.…”

“…To improve the quality of care for patients with a hip fracture, the nationwide Dutch Hip Fracture Audit (DHFA) was established in the Netherlands in 2016 [1] . Prospective collection of data on patient characteristics, logistic hip fracture processes and outcome parameters is an important part of this audit [1] . At the time the DHFA was developed, hip fracture audits were already up and running in several other countries.…”