Improved care and fewer deaths since introduction of NHS hip fracture initiative
Substantial improvements in the care and survival of older people with hip fracture in England have followed the introduction of a collaborative national initiative to tackle the issue, according to a new study published in the Medical Care journal.
The UK National Hip Fracture Database (NHFD) is a clinician-led audit initiative launched in 2007 as a collaboration between the British Orthopaedic Association (BOA) and British Geriatrics Society (BGS). The BOA/BGS published six national clinical standards for hip fracture care, including early surgery, and access to acute geriatric care. The NHFD uses data collection and feedback to support hospital clinical teams in monitoring their performance against these standards and improving their care.
To produce the first external evaluation of the NHFD initiative, researchers led by the London School of Hygiene & Tropical Medicine and The Royal College of Surgeons of England used routinely collected data on 471,590 older people (aged 60 and older) admitted with a hip fracture to NHS hospitals in England between 2003 and 2011. They compared data from 2003 to 2007 (before the introduction of the NHFD) and from 2007 to 2011 to determine improvements in the use of early surgery (on the day of, or the day after admission) and mortality at 30 days from admission.
From 2007 to 2011, among the patients who had surgery, the rate of early surgery increased from 54.5 per cent to 71.3 per cent, whereas the rate remained stable in the 2003–2007 period. The proportion of patients who died within 30 days of being admitted to hospital with a fractured hip decreased from 10.9 per cent to 8.5 per cent from 2007–2011, compared with a small reduction from 11.5 per cent to 10.9 per cent from 2003 to 2007. The number of hospitals participating in the initiative increased from 11 in 2007 to 175 in 2011.
Lead author Jenny Neuburger, lecturer in statistics at the London School of Hygiene & Tropical Medicine, said: “Our findings suggest that the launch of the National Hip Fracture Database in 2007 prompted substantial improvements in care and survival of older people with hip fracture in England. We estimate that by 2011, around 1000 fewer people a year died within 30 days of hospital admission for hip fracture than would be expected had pre-2007 trends continued.
“As well as a reduction in 30-day mortality, the results show a reduction in 90- and 365-day mortality. This suggests that better hip fracture care doesn’t simply defer early mortality, but that improved longer-term survival is sustained.
“The ageing population means the number of older people being admitted to hospital with hip fracture is likely to increase. Early surgery, dedicated medical care and rehabilitation following hip fracture can improve patient outcomes and decrease costs.”
The authors noted some limitations to the study, including the quality and scope of the routinely collected data. They also highlighted that other concurrent national policies could have contributed to the effects observed in the study.