Implementing a hip fracture registry and financial incentive program to enhance best practice in hip fracture care in Western Australia

2021 ◽  
Author(s):  
Hannah Seymour ◽  
Diana Fajardo Pulido ◽  
Amanda Ling ◽  
Rebecca Mitchell
Keyword(s):  
Hip Fracture ◽  
Western Australia ◽  
Best Practice ◽  
Financial Incentive ◽  
Fracture Care ◽  
Incentive Program

Improving hip fracture care: striving for excellence

2013 ◽  
Vol 23 (3) ◽  
pp. 223-233 ◽  
Author(s):  
N Nandi ◽  
M Maddula ◽  
O Sahota
Keyword(s):  
Cognitive Impairment ◽  
Hip Fracture ◽  
Older People ◽  
Best Practice ◽  
Enhanced Recovery ◽  
Fracture Care ◽  
Enhanced Recovery Pathway

SummaryHip fracture is a common and potentially devastating injury that occurs mainly in older people. The incidence is predicted to rise by 30% in the next 10 years alone. Many of those who recover suffer a loss of mobility and independence. There is growing emphasis to improve the care of patients sustaining hip fracture, especially in those with concurrent cognitive impairment. This review focuses on current best practice as well as several key areas of management, including analgesia, anaemia and nutrition. In doing so, we hope to identify interventions that may form the basis of a future Enhanced Recovery Pathway dedicated to hip fracture care.

scholarly journals Key Service Improvements After the Introduction of an Integrated Orthogeriatric Service

2019 ◽  
Vol 10 ◽  
pp. 215145931989389 ◽  
Author(s):  
R. P. Murphy ◽  
C. Reddin ◽  
E. P. Murphy ◽  
R. Waters ◽  
C. G. Murphy ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Hip Fractures ◽  
Performance Indicators ◽  
Functional Outcomes ◽  
Best Practice ◽  
Standards Of Care ◽  
Fracture Care ◽  
Best Practice Guidelines ◽  
Improve Compliance

Introduction: Models of orthogeriatric care have been shown to improve functional outcomes for patients after hip fractures and can improve compliance with best practice guidelines for hip fracture care. Methods: We evaluated improvements to key performance indicators in hip fracture care after implementation of a formal orthogeriatric service. Compliance with Irish Hip Fracture standards of care was reviewed, and additional outcomes such as length of stay, access to rehabilitation, and discharge destination were evaluated. Results: Improvements were observed in all of the hip fracture standards of care. Mean length of stay decreased from 19 to 15.5 days (mean difference 3.5 days; P < .05). A higher proportion of patients were admitted to rehabilitation (16.7% vs 7.9%, P < .05), and this happened in a timelier fashion (17.8 vs 24.8 days, P < .05). We found that less patients required convalescence post-hip fracture. Discussion: A standardized approach to integrated post-hip fracture care with orthogeriatrics has improved standards of care for patients. Conclusion: Introduction of orthogeriatric services has resulted in meaningful improvements in clinical outcomes for older people with hip fractures.

scholarly journals Prior Admissions as a Risk Factor for Readmission in Patients Surgically Treated for Femur Fractures: Implications for a Potential Hip Fracture Bundle

2021 ◽  
Vol 12 ◽  
pp. 215145932199616
Author(s):  
Robert Erlichman ◽  
Nicholas Kolodychuk ◽  
Joseph N. Gabra ◽  
Harshitha Dudipala ◽  
Brook Maxhimer ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Hip Fracture ◽  
Logistic Regression Analysis ◽  
Hip Fractures ◽  
Surgical Procedure ◽  
Hospital Admissions ◽  
Fracture Care ◽  
Increased Risk ◽  
Payment Models

Introduction: Hip fractures are a significant economic burden to our healthcare system. As there have been efforts made to create an alternative payment model for hip fracture care, it will be imperative to risk-stratify reimbursement for these medically comorbid patients. We hypothesized that patients readmitted to the hospital within 90 days would be more likely to have a recent previous hospital admission, prior to their injury. Patients with a recent prior admission could therefore be considered higher risk for readmission and increased cost. Methods: A retrospective chart review identified 598 patients who underwent surgical fixation of a hip or femur fracture. Data on readmissions within 90 days of surgical procedure and previous admissions in the year prior to injury resulting in surgical procedure were collected. Logistic regression analysis was used to determine if recent prior admission had increased risk of 90-day readmission. A subgroup analysis of geriatric hip fractures and of readmitted patients were also performed. Results: Having a prior admission within one year was significantly associated (p < 0.0001) for 90-day readmission. Specifically, logistic regression analysis revealed that a prior admission was significantly associated with 90-day readmission with an odds ratio of 7.2 (95% CI: 4.8-10.9). Discussion: This patient population has a high rate of prior hospital admissions, and these prior admissions were predictive of 90-day readmission. Alternative payment models that include penalties for readmissions or fail to apply robust risk stratification may unjustly penalize hospital systems which care for more medically complex patients. Conclusions: Hip fracture patients with a recent prior admission to the hospital are at an increased risk for 90-day readmission. This information should be considered as alternative payment models are developed for hip fracture care.

scholarly journals Too Cool? Hip Fracture Care and Maintaining Body Temperature

2020 ◽  
Vol 11 ◽  
pp. 215145932094947
Author(s):  
James Arkley ◽  
Suhib Taher ◽  
Ján Dixon ◽  
Gemma Dietz-Collin ◽  
Stacey Wales ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Temperature Control ◽  
Functional Outcomes ◽  
Surgical Site Infections ◽  
Fragility Fractures ◽  
Perioperative Period ◽  
Readmission Rates ◽  
Comprehensive Review ◽  
Fracture Care ◽  
Increase Risk

Introduction: Patients with hip fractures can become cold during the perioperative period despite measures applied to maintain warmth. Poor temperature control is linked with increasing complications and poorer functional outcomes. There is generic evidence for the benefits of maintaining normothermia, however this is sparse where specifically concerning hip fracture. We provide the first comprehensive review in this population. Significance: Large studies have revealed dramatic impact on wound infection, transfusion rates, increased morbidity and mortality. With very few studies relating to hip fracture patients, this review aimed to capture an overview of available literature regarding hypothermia and its impact on outcomes. Results: Increased mortality, readmission rates and surgical site infections are all associated with poor temperature control. This is more profound, and more common, in older frail patients. Increasing age and lower BMI were recognized as demographic factors that increase risk of hypothermia, which was routinely identified within modern day practice despite the use of active warming. Conclusion: There is a gap in research related to fragility fractures and how hypothermia impacts outcomes. Inadvertent intraoperative hypothermia still occurs routinely, even when active warming and cotton blankets are applied. No studies documented temperature readings postoperatively once patients had been returned to the ward. This is a point in the timeline where patients could be hypothermic. More studies need to be performed relating to this area of surgery.

scholarly journals Orthogeriatrics and Hip Fracture Care in the UK: Factors Driving Change to More Integrated Models of Care

Geriatrics ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 55 ◽  
Author(s):  
Mark Middleton
Keyword(s):  
Hip Fracture ◽  
Financial Incentives ◽  
Models Of Care ◽  
Social Needs ◽  
Medical Rehabilitation ◽  
Integrated Models ◽  
National Guidelines ◽  
Fracture Care ◽  
The Uk ◽  
The Impact

In the United Kingdom (UK), approximately 80,000 hip fractures each year result in an estimated annual cost of two billion pounds in direct healthcare costs alone. Various models of care exist for collaboration between orthopaedic surgeons and geriatricians in response to the complex medical, rehabilitation, and social needs of this patient group. Mounting evidence suggests that more integrated models of orthogeriatric care result in superior quality of care indicators and clinical outcomes. Clinical governance through national guidelines, audit through the National Hip Fracture Database (NHFD), and financial incentives through the Best Practice Tariff (providing a £1335 bonus for each patient) have driven hip fracture care in the UK forward. The demanded improvement in quality indicators has increased the popularity of collaborative care models and particularly integrated orthogeriatric services. A significant fall in 30-day mortality has resulted nationally. Ongoing data collection by the NHFD will lead to greater understanding of the impact of all elements of hip fracture care including models of orthogeriatrics.

Thromboprophylaxis practice patterns in hip fracture surgery patients: experience in Perth, Western Australia

2003 ◽  
Vol 73 (10) ◽  
pp. 826-829 ◽  
Author(s):  
Susan Wan ◽  
Jeannette Ting ◽  
Amanda Olsen ◽  
John Croser ◽  
John W. Eikelboom
Keyword(s):  
Hip Fracture ◽  
Western Australia ◽  
Practice Patterns ◽  
Hip Fracture Surgery ◽  
Patients Experience ◽  
Fracture Surgery

scholarly journals Physician attitudes toward participating in a financial incentive program for LDL reduction are associated with patient outcomes

Healthcare ◽  
2017 ◽  
Vol 5 (3) ◽  
pp. 119-124 ◽  
Author(s):  
Tianyu Liu ◽  
David A. Asch ◽  
Kevin G. Volpp ◽  
Jingsan Zhu ◽  
Wenli Wang ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Financial Incentive ◽  
Physician Attitudes ◽  
Incentive Program

scholarly journals Achieving best practice tariff may not reflect improved survival after hip fracture treatment

2014 ◽  
pp. 2097 ◽  
Author(s):  
Khan ◽  
Mark Shirley ◽  
Clare Glennie ◽  
Paul Fearon ◽  
David Deehan
Keyword(s):  
Hip Fracture ◽  
Best Practice ◽  
Fracture Treatment

HipMod: Development of a Multi-Agent Audit-Based Computer Simulation of Hip Fracture Care

2003 ◽  
Vol 9 (3) ◽  
pp. 183-197 ◽  
Author(s):  
C. T. Currie ◽  
D. Hoy ◽  
A. J. Tierney ◽  
J. Bryan-Jones ◽  
I. Lapsley
Keyword(s):  
Computer Simulation ◽  
Hip Fracture ◽  
Fracture Care ◽  
Multi Agent
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