Sammanfattning
Objectives: To examine the association between process performance measures and clinical outcome among patients with hip fracture.
Design: Nationwide, population-based follow-up study.
Setting: Danish public hospitals
Participants: A total of 25,354 patients 65 years or older who were hospitalised with a hip fracture in Denmark between 2010 and 2013.
Intervention: The process performance measures, including systematic pain assessment, early mobilization, basic mobility assessment upon admission and at discharge, post-discharge rehabilitation program, anti-osteoporotic medication and prevention of future fall accidents measures, were analysed individually, and applied as an opportunity-based score defined as the proportion of all relevant performance measures fulfilled for the individual patient (0-50%, 50-75%, 75-100%).
Outcomes measures: 30-day mortality, 30-day readmission after discharge and length of stay (LOS).
Results: Fulfilling 75-100% of the relevant process performance measures was associated with lower 30-day mortality (22.6% vs. 8.5%, adjusted odds ratio (OR) = 0.31 (95% CI:0.28-0.35)) and lower odds of readmission (21.7% vs. 17.4%, adjusted OR=0.78 (95% CI:0.70-0.87)). The overall opportunity score for quality of care was not associated with LOS (adjusted OR =1.00 (95% CI: 0.98-1.04). Mobilization within 24 hours post-operatively was the process with the strongest association with lower 30-day mortality, readmission risk and shorter LOS.
Conclusions: Higher quality of in-hospital care and early mobilization were associated with a better clinical outcome, including lower 30-day mortality, among patients with hip fracture.