Quality of Care in Hip Fracture Patients

The Relationship Between Adherence to National Standards and Improved Outcomes

Luke Farrow, Andrew Hall, Adrian D. Wood, Rik Smith, Kate James, Graeme Holt, Phyo K. Myint, James Hutchison

Research output: Contribution to journalArticle

3 Citations (Scopus)
6 Downloads (Pure)

Abstract

Background: Optimizing the perioperative care of patients with a hip fracture is a key health-care priority. We aimed to determine whether adherence to the Scottish Standards of Care for Hip Fracture Patients (SSCHFP) was associated with improved patient outcomes.Methods: In this retrospective cohort study of prospectively collected data from the Scottish National Hip Fracture Audit, we assessed adherence to the SSCHFP in 21 Scottish hospitals over a 9-month period in 2014 and examined the effect of the guidelines on 30 and 120-day mortality, length of hospital stay, and discharge destination.Results: A total of 1,162 patients who were ≥50 years old and admitted with a hip fracture were included. There was a significant association between low adherence to the SSCHFP and increased mortality at 30 and 120 days (odds ratio [OR], 3.58 [95% confidence interval (CI), 1.75 to 7.32; p < 0.001] and 2.01 [95% CI, 1.28 to 3.12; p = 0.003], respectively). Low adherence was associated with a reduced likelihood of a short length of stay (OR, 0.58; 95% CI, 0.42 to 0.78; p < 0.0001), but increased odds of discharge to a high-care setting (OR, 1.63; 95% CI, 1.12 to 2.36; p = 0.01). Early physiotherapy input and occupational therapy input were associated with a reduced likelihood of discharge to a high-care setting (OR, 0.64 [95% CI, 0.44 to 0.98; p = 0.04] and 0.34 [95% CI, 0.23 to 0.48; p <0.001], respectively).Conclusions: Adherence to the SSCHFP is associated with better patient outcomes. These findings confirm the clinical utility of the SSCHFP and support their use as a benchmarking tool to improve quality of care for hip fractures.Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Original languageEnglish
Pages (from-to)751-757
Number of pages7
JournalThe Journal of Bone & Joint Surgery. American Volume
Volume100
Issue number9
DOIs
Publication statusPublished - 2 May 2018

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Quality of Health Care
Hip Fractures
Standard of Care
Confidence Intervals
Odds Ratio
Length of Stay
Perioperative Care
Benchmarking
Health Priorities
Mortality
Occupational Therapy
Cohort Studies
Retrospective Studies
Guidelines
Delivery of Health Care

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Quality of Care in Hip Fracture Patients : The Relationship Between Adherence to National Standards and Improved Outcomes. / Farrow, Luke; Hall, Andrew; Wood, Adrian D.; Smith, Rik; James, Kate; Holt, Graeme; Myint, Phyo K.; Hutchison, James.

In: The Journal of Bone & Joint Surgery. American Volume, Vol. 100, No. 9, 02.05.2018, p. 751-757.

Research output: Contribution to journalArticle

Farrow, Luke ; Hall, Andrew ; Wood, Adrian D. ; Smith, Rik ; James, Kate ; Holt, Graeme ; Myint, Phyo K. ; Hutchison, James. / Quality of Care in Hip Fracture Patients : The Relationship Between Adherence to National Standards and Improved Outcomes. In: The Journal of Bone & Joint Surgery. American Volume. 2018 ; Vol. 100, No. 9. pp. 751-757.
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abstract = "Background: Optimizing the perioperative care of patients with a hip fracture is a key health-care priority. We aimed to determine whether adherence to the Scottish Standards of Care for Hip Fracture Patients (SSCHFP) was associated with improved patient outcomes.Methods: In this retrospective cohort study of prospectively collected data from the Scottish National Hip Fracture Audit, we assessed adherence to the SSCHFP in 21 Scottish hospitals over a 9-month period in 2014 and examined the effect of the guidelines on 30 and 120-day mortality, length of hospital stay, and discharge destination.Results: A total of 1,162 patients who were ≥50 years old and admitted with a hip fracture were included. There was a significant association between low adherence to the SSCHFP and increased mortality at 30 and 120 days (odds ratio [OR], 3.58 [95{\%} confidence interval (CI), 1.75 to 7.32; p < 0.001] and 2.01 [95{\%} CI, 1.28 to 3.12; p = 0.003], respectively). Low adherence was associated with a reduced likelihood of a short length of stay (OR, 0.58; 95{\%} CI, 0.42 to 0.78; p < 0.0001), but increased odds of discharge to a high-care setting (OR, 1.63; 95{\%} CI, 1.12 to 2.36; p = 0.01). Early physiotherapy input and occupational therapy input were associated with a reduced likelihood of discharge to a high-care setting (OR, 0.64 [95{\%} CI, 0.44 to 0.98; p = 0.04] and 0.34 [95{\%} CI, 0.23 to 0.48; p <0.001], respectively).Conclusions: Adherence to the SSCHFP is associated with better patient outcomes. These findings confirm the clinical utility of the SSCHFP and support their use as a benchmarking tool to improve quality of care for hip fractures.Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.",
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T1 - Quality of Care in Hip Fracture Patients

T2 - The Relationship Between Adherence to National Standards and Improved Outcomes

AU - Farrow, Luke

AU - Hall, Andrew

AU - Wood, Adrian D.

AU - Smith, Rik

AU - James, Kate

AU - Holt, Graeme

AU - Myint, Phyo K.

AU - Hutchison, James

PY - 2018/5/2

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N2 - Background: Optimizing the perioperative care of patients with a hip fracture is a key health-care priority. We aimed to determine whether adherence to the Scottish Standards of Care for Hip Fracture Patients (SSCHFP) was associated with improved patient outcomes.Methods: In this retrospective cohort study of prospectively collected data from the Scottish National Hip Fracture Audit, we assessed adherence to the SSCHFP in 21 Scottish hospitals over a 9-month period in 2014 and examined the effect of the guidelines on 30 and 120-day mortality, length of hospital stay, and discharge destination.Results: A total of 1,162 patients who were ≥50 years old and admitted with a hip fracture were included. There was a significant association between low adherence to the SSCHFP and increased mortality at 30 and 120 days (odds ratio [OR], 3.58 [95% confidence interval (CI), 1.75 to 7.32; p < 0.001] and 2.01 [95% CI, 1.28 to 3.12; p = 0.003], respectively). Low adherence was associated with a reduced likelihood of a short length of stay (OR, 0.58; 95% CI, 0.42 to 0.78; p < 0.0001), but increased odds of discharge to a high-care setting (OR, 1.63; 95% CI, 1.12 to 2.36; p = 0.01). Early physiotherapy input and occupational therapy input were associated with a reduced likelihood of discharge to a high-care setting (OR, 0.64 [95% CI, 0.44 to 0.98; p = 0.04] and 0.34 [95% CI, 0.23 to 0.48; p <0.001], respectively).Conclusions: Adherence to the SSCHFP is associated with better patient outcomes. These findings confirm the clinical utility of the SSCHFP and support their use as a benchmarking tool to improve quality of care for hip fractures.Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

AB - Background: Optimizing the perioperative care of patients with a hip fracture is a key health-care priority. We aimed to determine whether adherence to the Scottish Standards of Care for Hip Fracture Patients (SSCHFP) was associated with improved patient outcomes.Methods: In this retrospective cohort study of prospectively collected data from the Scottish National Hip Fracture Audit, we assessed adherence to the SSCHFP in 21 Scottish hospitals over a 9-month period in 2014 and examined the effect of the guidelines on 30 and 120-day mortality, length of hospital stay, and discharge destination.Results: A total of 1,162 patients who were ≥50 years old and admitted with a hip fracture were included. There was a significant association between low adherence to the SSCHFP and increased mortality at 30 and 120 days (odds ratio [OR], 3.58 [95% confidence interval (CI), 1.75 to 7.32; p < 0.001] and 2.01 [95% CI, 1.28 to 3.12; p = 0.003], respectively). Low adherence was associated with a reduced likelihood of a short length of stay (OR, 0.58; 95% CI, 0.42 to 0.78; p < 0.0001), but increased odds of discharge to a high-care setting (OR, 1.63; 95% CI, 1.12 to 2.36; p = 0.01). Early physiotherapy input and occupational therapy input were associated with a reduced likelihood of discharge to a high-care setting (OR, 0.64 [95% CI, 0.44 to 0.98; p = 0.04] and 0.34 [95% CI, 0.23 to 0.48; p <0.001], respectively).Conclusions: Adherence to the SSCHFP is associated with better patient outcomes. These findings confirm the clinical utility of the SSCHFP and support their use as a benchmarking tool to improve quality of care for hip fractures.Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

U2 - 10.2106/JBJS.17.00884

DO - 10.2106/JBJS.17.00884

M3 - Article

VL - 100

SP - 751

EP - 757

JO - The Journal of Bone & Joint Surgery. American Volume

JF - The Journal of Bone & Joint Surgery. American Volume

SN - 0021-9355

IS - 9

ER -