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Multiple hospital organisational factors are associated with adverse patient outcomes post-hip fracture in England and Wales: the REDUCE record-linkage cohort study
| Content Provider | Oxford Academic |
|---|---|
| Author | Patel, Rita Judge, Andrew Johansen, Antony Marques, Elsa M R Griffin, Jill Bradshaw, Marianne Drew, Sarah Whale, Katie Chesser, Tim Griffin, Xavier L Javaid, Muhammad K Ben-Shlomo, Yoav Gregson, Celia L |
| Copyright Year | 2022 |
| Abstract | Objectives: Despite established standards and guidelines, substantial variation remains in the delivery of hip fracture care across the United Kingdom. We aimed to determine which hospital-level organisational factors predict adverse patient outcomes in the months following hip fracture.MethodsWe examined a national record-linkage cohort of 178,757 patients aged ≥60 years who sustained a hip fracture in England and Wales in 2016–19. Patient-level hospital admissions datasets, National Hip Fracture Database and mortality data were linked to metrics from 18 hospital-level organisational-level audits and reports. Multilevel models identified organisational factors, independent of patient case-mix, associated with three patient outcomes: length of hospital stay (LOS), 30-day all-cause mortality and emergency 30-day readmission.ResultsAcross hospitals mean LOS ranged from 12 to 41.9 days, mean 30-day mortality from 3.7 to 10.4% and mean readmission rates from 3.7 to 30.3%, overall means were 21.4 days, 7.3% and 15.3%, respectively. In all, 22 organisational factors were independently associated with LOS; e.g. a hospital's ability to mobilise >90% of patients promptly after surgery predicted a 2-day shorter LOS (95% confidence interval [CI]: 1.2–2.6). Ten organisational factors were independently associated with 30-day mortality; e.g. discussion of patient experience feedback at clinical governance meetings and provision of prompt surgery to >80% of patients were each associated with 10% lower mortality (95%CI: 5–15%). Nine organisational factors were independently associated with readmissions; e.g. readmissions were 17% lower if hospitals reported how soon community therapy would start after discharge (95%CI: 9–24%).ConclusionsReceipt of hip fracture care should be reliable and equitable across the country. We have identified multiple, potentially modifiable, organisational factors associated with important patient outcomes following hip fracture. |
| Related Links | https://academic.oup.com/ageing/article-pdf/51/8/afac183/45626324/afac183.pdf |
| File Format | |
| ISSN | 00020729 |
| e-ISSN | 14682834 |
| DOI | 10.1093/ageing/afac183 |
| Journal | Age and Ageing |
| Issue Number | 8 |
| Volume Number | 51 |
| Language | English |
| Publisher | Oxford Academic |
| Publisher Date | 2022-08-02 |
| Access Restriction | Open |
| Subject Keyword | Clinical Medicine Geriatric Medicine Medicine and Health Hip Fracture Organisational Factors Patient Outcomes Mortality Length of Stay |
| Content Type | Text |
| Resource Type | Article |
| Subject | Aging Geriatrics and Gerontology |
