Quality indicators for hip fracture care, a systematic review

Abstract

Quality indicators are used to measure quality of care and enable benchmarking. An overview of all existing hip fracture quality indicators is lacking. The primary aim was to identify quality indicators for hip fracture care reported in literature, hip fracture audits, and guidelines. The secondary aim was to compose a set of methodologically sound quality indicators for the evaluation of hip fracture care in clinical practice. A literature search according to the PRISMA guidelines and an internet search were performed to identify hip fracture quality indicators. The indicators were subdivided into process, structure, and outcome indicators. The methodological quality of the indicators was judged using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. For structure and process indicators, the construct validity was assessed. Sixteen publications, nine audits and five guidelines were included. In total, 97 unique quality indicators were found: 9 structure, 63 process, and 25 outcome indicators. Since detailed methodological information about the indicators was lacking, the AIRE instrument could not be applied. Seven indicators correlated with an outcome measure. A set of nine quality indicators was extracted from the literature, audits, and guidelines. Many quality indicators are described and used. Not all of them correlate with outcomes of care and have been assessed methodologically. As methodological evidence is lacking, we recommend the extracted set of nine indicators to be used as the starting point for further clinical research. Future research should focus on assessing the clinimetric properties of the existing quality indicators.

Regulatory Measures Expedited Hip Fracture Surgery Without Lowering Overall Patient Mortality

“…One‐year mortality was not assessed. Several other studies, however, did not report reduction of mortality with early surgery …”

“…Multiple quality indicators of hip fracture care, such as structure, process, and outcome, were proposed in recent years. One systematic review identified 97 unique quality indicators, not all of which correlated with outcomes . The time‐to‐surgery indicator was defined by different studies as being 24, 36, or 48 hours.…”

“…One systematic review identified 97 unique quality indicators, not all of which correlated with outcomes. 18 The time-to-surgery indicator was defined by different studies as being 24, 36, or 48 hours. In a study by Khan et al, the introduction of an early surgery goal along with an improved orthogeriatric care resulted in reduced mortality.…”

“…Several other studies, however, did not report reduction of mortality with early surgery. 18,[21][22][23] Biological reasoning for an association between a delay in performing surgery and increased mortality has never been firmly established. Overall higher mortality after hip fractures compared to healthy community controls 24,25 had been explained by the occurrence of preoperative and perioperative complications and the accelerated effect of trauma on aging.…”

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

“…The level of pre-fracture mobility has proven to be an important predictor for 30-day mortality in frail hip fracture patients [ 12 , 13 ]. In addition, a mobility score can be used to monitor the post-operative recovery process, and the return to pre-fracture mobility is used as a quality indicator [14] . The mobility score that the Fragility Fracture Network (FFN) decided to use for audits on care for hip fracture patients, is the Fracture Mobility Score [15] .…”