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. 2019 Aug;101-B(8):1015-1023.
doi: 10.1302/0301-620X.101B8.BJJ-2019-0173.R1.

Pay for performance and hip fracture outcomes: an interrupted time series and difference-in-differences analysis in England and Scotland

D Metcalfe  1 , C K Zogg  2 , A Judge  3   4   5   6 , D C Perry  1 , B Gabbe  7 , K Willett  1 , M L Costa  1
Affiliations

Pay for performance and hip fracture outcomes: an interrupted time series and difference-in-differences analysis in England and Scotland

D Metcalfe et al. Bone Joint J. 2019 Aug.

Abstract

Aims: Hip fractures are associated with high morbidity, mortality, and costs. One strategy for improving outcomes is to incentivize hospitals to provide better quality of care. We aimed to determine whether a pay-for-performance initiative affected hip fracture outcomes in England by using Scotland, which did not participate in the scheme, as a control.

Materials and methods: We undertook an interrupted time series study with data from all patients aged more than 60 years with a hip fracture in England (2000 to 2018) using the Hospital Episode Statistics Admitted Patient Care (HES APC) data set linked to national death registrations. Difference-in-differences (DID) analysis incorporating equivalent data from the Scottish Morbidity Record was used to control for secular trends. The outcomes were 30-day and 365-day mortality, 30-day re-admission, time to operation, and acute length of stay.

Results: There were 1 037 860 patients with a hip fracture in England and 116 594 in Scotland. Both 30-day (DID -1.7%; 95% confidence interval (CI) -2.0 to -1.2) and 365-day (-1.9%; 95% CI -2.5 to -1.3) mortality fell in England post-intervention when compared with outcomes in Scotland. There were 7600 fewer deaths between 2010 and 2016 that could be attributed to interventions driven by pay-for-performance. A pre-existing annual trend towards increased 30-day re-admissions in England was halted post-intervention. Significant reductions were observed in the time to operation and length of stay.

Conclusion: This study provides evidence that a pay-for-performance programme improved the outcomes after a hip fracture in England. Cite this article: Bone Joint J 2019;101-B:1015-1023.

Keywords: Best practice tariff; Hip fracture; Pay-for-performance.

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Figures

Fig. 1
Fig. 1
Charts showing monthly changes in a) 30-, b) 90- and c) 365-day mortality among adults aged more than 60 years, 2000 to 2016. Dashed lines represent introduction of the National Hip Fracture Database in January 2007 and the Best Practice Tariff in April 2010.
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