Introduction of NHS hip fracture initiative leads to better care
The Medical Care journal has just published a new study that shows considerable improvements in the elderly as a result of a national hip fracture initiative, including their care and survival rate. Hip fracture is a serious injury that is rife throughout the UK and the US; with approximately 70,000 cases a year in the first and 250,000 cases in the latter in people over the age of 60.
Since 2007, a collaborative initiative between the British Orthopaedic Association and British Geriatrics Society called the UK National Hip Fracture Database (NHFD) has been using data collection and feedback to monitor hospital clinical teams’ performance. In order to do this, the initiative created six national clinical standards for hip fracture care, which included patient access to acute geriatric care and early surgery, and used these as the benchmark for comparison with the collected data in order to see where patient care could be improved.
Data from 471,590 people aged 60 and older with a hip fracture was collected routinely between 2003 and 2011 in NHS hospitals in England. This data was researched by the London School of Hygiene & Tropical Medicine and The Royal College of Surgeons of England to produce the NHFD initiative’s first external evaluation. The data was split into before and after the introduction of NHFD (2003 – 2007 and 2007-2011) so that improvements to care and mortality rates could be measured. Specifically, researchers were looking for improvements in the use of early surgery and mortality rates in the 30 days following admission.
The report found that where the rate of early surgery had remained stable between 2003-2007, it had actually increased from 2007 to 2011. It also found a reduction in mortality rates in the 30 days after admission, decreasing from 10.9% to 8.5% from 2007-2011, a greater reduction than the 11.5% to 10.9% found between 2003-2007. Overall, the annual relative reduction shifted from just 1.8% per year in the 2003-2007 year and increased to 7.6% in the 2007-2011 period when the initiative was introduced. It is worth noting that the participating hospitals in this initiative increased to 175 in 2011, up from 11 at the start in 2007.
Dr Jenny Neuburger, Lead author and Lecturer at the London School of Hygiene & Tropical Medicine, said: “Our findings suggest that the launch of the National Hip Fracture Database in 2007 prompted substantial improvements in care and survival of older people with hip fracture in England. We estimate that by 2011, around 1,000 fewer people a year died within 30 days of hospital admission for hip fracture than would be expected had pre-2007 trends continued. “As well as a reduction in 30 day mortality, the results show a reduction in 90 and 365-day mortality. This suggests that better hip fracture care doesn’t simply defer early mortality, but that improved longer-term survival is sustained. “Hip fracture care is a substantial cost for the NHS each year. Our findings will be of particular interest to clinicians, commissioners and policy makers, especially given that the ageing population means the number of older people being admitted to hospital with hip fracture is likely to increase. Early surgery, dedicated medical care and rehabilitation following hip fracture can improve patient outcomes and decrease costs.”
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Colin Currie, clinical lead for geriatric medicine on the NHFD from 2004-2013 and Co-author of the report, said: “This study and its findings are important and very encouraging. Traditionally, audits have been self-reporting. But this analysis, using reliable before-and-after data, provides an external, objective assessment of the work of the NHFD since its launch in 2007. “Improved survival at 30, 90 and 365 days reflects improved early care by clinical teams in which orthopaedic surgeons and geriatricians work together. This has saved lives and substantially reduced the medium term impact of a common, serious and much-feared injury affecting mainly older people. “This study is, quite simply, the best evidence yet that hip fracture audit really can make a difference.”
Some limitations were noted in the study by the author, notably that other concurrent national policies could have contributed to observed effects, and the routinely collected data’s quality and scope is limited.
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