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. 2015 Aug;53(8):686-91.
doi: 10.1097/MLR.0000000000000383.

The impact of a national clinician-led audit initiative on care and mortality after hip fracture in England: an external evaluation using time trends in non-audit data

Jenny Neuburger  1 , Colin Currie, Robert Wakeman, Carmen Tsang, Fay Plant, Bianca De Stavola, David A Cromwell, Jan van der Meulen
Affiliations

The impact of a national clinician-led audit initiative on care and mortality after hip fracture in England: an external evaluation using time trends in non-audit data

Jenny Neuburger et al. Med Care. 2015 Aug.

Abstract

Background: Hip fracture is the most common serious injury of older people. The UK National Hip Fracture Database (NHFD) was launched in 2007 as a national collaborative, clinician-led audit initiative to improve the quality of hip fracture care, but has not yet been externally evaluated.

Methods: We used routinely collected data on 471,590 older people (aged 60 years and older) admitted with a hip fracture to National Health Service (NHS) hospitals in England between 2003 and 2011. The main variables of interest were the use of early surgery (on day of admission, or day after) and mortality at 30 days from admission. We compared time trends in the periods 2003-2007 and 2007-2011 (before and after the launch of the NHFD), using Poisson regression models to adjust for demographic changes.

Findings: The number of hospitals participating in the NHFD increased from 11 in 2007 to 175 in 2011. From 2007 to 2011, the rate of early surgery increased from 54.5% to 71.3%, whereas the rate had remained stable over the period 2003-2007. Thirty-day mortality fell from 10.9% to 8.5%, compared with a small reduction from 11.5% to 10.9% previously. The annual relative reduction in adjusted 30-day mortality was 1.8% per year in the period 2003-2007, compared with 7.6% per year over 2007-2011 (P<0.001 for the difference).

Interpretation: The launch of a national clinician-led audit initiative was associated with substantial improvements in care and survival of older people with hip fracture in England.

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Conflict of interest statement

R.W., C.C., and F.P. were funded as members of the NHFD implementation group; J.N. was formerly and C.T. and D.C. are currently commissioned by the Royal College of Physicians to analyze data for the NHFD annual reports as part of the Falls and Fragility Fractures Audit Programme (FFFAP). R.W. is clinical lead for orthopedic surgery on the NHFD. C.C. was a clinical lead for geriatric medicine on the National Hip Fracture Database (NHFD) from 2004 to 2013. F.P. was the project coordinator on the NHFD from 2009 to 2013. The remaining authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Time trends in 30-day mortality in the periods 2003–2007 and 2007–2011. Y axis is on log scale, with labels on natural scale. Time is measured in 3-month intervals.
See this image and copyright information in PMC

References

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