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

Lookup NU author(s): Dr Mark Shirley, Paul Fearon, Professor David Deehan

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Abstract

Objective: The best practice tariff (BPT) incentivizes hospitals in the England and Wales National Health Service to provide multiprofessional care to patients with hip fractures. The initial six targets included: 1) admission under consultant-led joint orthopedic-geriatric care, 2) multidisciplinary assessment protocol on admission, 3) surgery within 36 hours, 4) geriatrician review within 72 hours, 5) multiprofessional rehabilitation, and 6) assessment for falls and bone protection. We aimed to examine the relationship between BPT achievement and important patient outcomes and whether the BPT could predict these independently of other validated predictors.Materials and methods: A retrospective review was conducted on 516 patient episodes. Four outcomes were defined: 1) 30-day mortality, 2) 365-day mortality, 3) postoperative length of stay on trauma ward (LOS-T), and 4) total post-operative hospital LOS (LOS-H). Patient episodes were grouped as follows: 1) group 1, pre-BPT, 2) group 2, BPT achievers, 3) group 3, BPT fails. These were compared for mortality (chi(2) test) and for LOS (Kruskal-Wallis test). Event analysis was done for groups 2 and 3 using generalized linear modeling, with age, sex, American Society of Anesthesiologists grade, hemoglobin, albumin, creatinine, and BPT achievement evaluated as predictors.Results: The three groups did not differ significantly in baseline characteristics or outcomes. In the event analysis, the risk of 30-day mortality was related only to abnormal creatinine (P=0.025); mortality at 365 days was related significantly to low albumin (P=0.023) and weakly to abnormal creatinine (P=0.089). The risks of both increased LOS-T and LOS-H were related to age only (P=0.052, P<0.001, respectively).Conclusion: Achieving BPT does not predict any outcome of interest on its own.

Publication metadata

Author(s): Khan SK, Shirley MDF, Glennie C, Fearon PV, Deehan DJ

Publication type: Article

Publication status: Published

Journal: Clinical Interventions in Aging

Year: 2014

Volume: 9

Pages: 2097-2102

Print publication date: 01/12/2014

Online publication date: 29/05/2014

ISSN (print): 1176-9092

ISSN (electronic): 1178-1998

Publisher: Dove Medical Press Ltd.

URL: http://dx.doi.org/10.2147/CIA.S65736

DOI: 10.2147/CIA.S65736

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