Introduction
Methods
Dutch Hip Fracture Audit
Subscription | - Hospital participation in the DHFA is not compulsory, but the four medical associations that jointly developed the DHFA dataset advised their members to participate. - A hospital can subscribe to participate, subject to agreement of its executive board. - Participation is free of costs. - There are no financial incentives for participation. |
Data gathering | - Data from the electronic health record needs to be entered into the Dutch Hip Fracture database. - The DHFA does not provide nationwide staffing or other resources or personal for the data gathering. - It is up to the local hospital to organise the data gathering process and to decide which medical professional(s) is (are) responsible for the data gathering process. - For all hip fracture patients of 18 years or older, 45 items need to be entered into a web-based survey spread at three different moments in the treatment process. - These three different moments are on admission, 3 months after admission and 1 year after admission. - Patients having a pathologic fracture due to a malignant disease or a periprosthetic fracture should not be registered. |
Advantages | - A weekly updated report to provide insight into the hospital’s own clinical performance on structures, processes and outcomes of hip fracture care - Hospitals’ clinical performances are also benchmarked. This can help hospitals determine how their treatment process can be optimised, and how specific intervention can be implemented to ensure a higher quality of hip fracture care. - All quality indicators, as demanded by the two supervisory government agencies, i.e. the National Health Care Institute and the Health and Youth Care Inspectorate, can be calculated from the DHFA database. This prevents that physicians have to register the same data in multiple databases. |
Identification of factors influencing participation in the DHFA
Development and distribution of the questionnaire
Total N (%) | Not participating in the DHFA, and not intending to do so N = 6 (5.5%) | Not participating in the DHFA, but intending to do so N = 29 (26.6%) | Partially participating in the DHFA, < 80% of patients registered N = 23 (21.1%) | Actively participating in the DHFA, ≥ 80% of patients registered N = 51 (46.8%) | |
---|---|---|---|---|---|
Type of surgeon | |||||
Orthopaedic surgeon | 22 (20.2%) | 1 (4.5%) | 11 (50.0%) | 3 (13.6%) | 7 (31.8%) |
Trauma surgeon | 87 (79.8%) | 5 (5.7%) | 18 (20.7%) | 20 (23.0%) | 44 (50.6%) |
Years of experience | |||||
1–5 years | 16 (14.7%) | 2 (12.5%) | 4 (25.0%) | 1 (6.3%) | 9 (56.3%) |
6–10 years | 33 (30.3%) | 1 (3.0%) | 10 (30.3%) | 5 (15.2%) | 17 (51.5%) |
11–15 years | 19 (17.4%) | 0 (0.0%) | 6 (31.6%) | 4 (21.1%) | 9 (47.4%) |
> 15 years | 41 (37.6%) | 3 (7.3%) | 9 (22.0%) | 13 (31.7%) | 16 (39%) |
Type of hospital | |||||
Academic hospital | 15 (13.8%) | 2 (13.3%) | 8 (53.3%) | 2 (13.3%) | 3 (20.0%) |
General hospital | 94 (86.2%) | 4 (4.3%) | 21 (22.3%) | 21 (22.3%) | 48 (51.1%) |
Annual number of operations | |||||
1–20 | 19 (17.4%) | 1 (5.3%) | 10 (52.6%) | 2 (10.5%) | 6 (31.6%) |
21–50 | 47 (43.1%) | 2 (4.3%) | 12 (25.5%) | 10 (21.3%) | 23 (48.9%) |
51–100 | 32 (29.4%) | 3 (9.4%) | 3 (9.4%) | 9 (28.1%) | 17 (53.1%) |
> 100 | 11 (10.1%) | 0 (0.0%) | 4 (36.4%) | 2 (18.2%) | 5 (45.5%) |
Familiar with DHFA | |||||
Yes | 102 (93.6%) | 2 (2.0%) | 26 (25.5%) | 23 (22.5%) | 51 (50.0%) |
No | 7 (6.4%) | 4 (57.1%) | 3 (42.9%) | 0 (0.0%) | 0 (0.0%) |
Analysis
Results
Factors most agreed on to influence participation in the DHFA
Resondents' agreement with statement among respondents | ||||
---|---|---|---|---|
Not participating in the DHFA N = 28 | Participating in the DHFA N = 74 | Degree of participation in the DHFA | ||
< 80% of the patients registered N = 23 | ≥ 80% of the patients registered N = 51 | |||
1. At hospitals, staffing capacity must be made available for DHFA data collection. | 27 (96.4%) | 70 (94.6%) | 22 (95.7%) | 48 (94.1%) |
2. Data entry into the DHFA from the electronic health record should be automated (registry at point of care). | 26 (92.9%) | 71 (95.9%) | 23 (100.0%) | 48 (94.1%) |
3. Participation in the DHFA must be supported financially by the hospital board. | 25 (89.3%) | 71 (95.9%) | 22 (95.7%) | 49 (96.1%) |
4. Implementation of the DHFA at hospital level requires a plan of action. | 25 (89.3%) | 69 (93.2%) | 21 (91.3%) | 48 (94.1%) |
5. The DHFA increases the registration load for physicians. | 27 (96.4%) | 63 (85.1%) | 20 (87.0%) | 43 (84.3%) |
6. The DHFA will provide insight into the actual quality of hip fracture care. | 26 (92.9%) | 63 (85.1%) | 18 (78.3%) | 45 (88.2%) |
7. To ensure the proper organisation of the DHFA in hospitals, cooperation between the specialist areas involved (surgery, orthopaedics, geriatrics, internal medicine) is essential. | 25 (89.3%) | 65 (87.8%) | 19 (82.6%) | 46 (90.2%) |
8. The DHFA is a tool for improving the quality of hip fracture care. | 24 (85.7%) | 62 (83.8%) | 18 (78.3%) | 44 (86.3%) |
9. Too much data is requested in the DHFA. | 22 (78.6%) | 64 (86.5%) | 20 (87.0%) | 44 (86.3%) |
10. The DHFA must do more than just give online feedback on outcomes. | 23 (82.1%) | 60 (81.1%) | 20 (87.0%) | 40 (78.4%) |
11. The DHFA should be linked with other sources (municipal registries, Dutch Arthroplasty Register and Dutch Trauma Registry). | 21 (75.0%) | 64 (86.5%) | 19 (82.6%) | 45 (88.2%) |
12. The added value of the DHFA lies in its being initiated and managed by medical practitioners themselves. | 23 (82.1%) | 55 (74.3%) | 17 (73.9%) | 38 (74.5%) |
13. I am confident that the DHFA handles data with due care | 21 (75.0%) | 54 (73.0%) | 15 (65.2%) | 39 (76.5%) |
14. The 3-month follow-up as required by the DHFA is not part of the standard clinical follow-up. | 18 (64.3%) | 59 (79.7%) | 19 (82.6%) | 40 (78.4%) |
15. I am confident that the DHFA working group will make a proper assessment what data (quality indicators) can be made available to external parties. | 19 (67.9%) | 50 (67.7%) | 12 (52.2%) | 38 (74.5%) |
16. The division of responsibilities for the execution of the DHFA between the specialists involved is not clear. | 18 (64.3%) | 49 (66.2%) | 16 (69.6%) | 33 (64.7%) |
17. For the DHFA, a nationwide registry requirement should be introduced. | 17 (60.7%) | 51 (68.9%) | 13 (56.5%) | 38 (74.5%) |
18. Data obtained from the DHFA offers relevant external parties (health insurers, National Health Care Institute) insight into the actual quality of hip fracture care. | 17 (60.7%) | 49 (66.2%) | 11 (47.8%) | 38 (74.5%) |
19. The benefits of participation in the DHFA do not outweigh the costs. | 15 (53.6%) | 38 (51.4%) | 15 (65.2%) | 23 (45.1%) |
20. The DHFA is going to lead to a cost reduction in hip fracture care. | 14 (50.0%) | 33 (44.6%) | 11 (47.8%) | 22 (43.1%) |
21. The added value of the DHFA is not clear. | 11 (39.3%) | 35 (47.3%) | 15 (65.2%) | 20 (39.2%) |
Factors associated with actual participation in the DHFA
Univariable OR (95% CI; p) | Multivariable OR (95% CI; p) | |
---|---|---|
Type of surgeon (orthopaedic vs. trauma surgeon) | 0.39 (0.14–1.12; 0.08) | 0.30 (0.10–0.90; 0.03) |
Type of hospital (academic vs. general) | 0.18 (0.05–0.62; 0.01) | 0.15 (0.04–0.52; < 0.01) |
Annual number of operations | ||
1–20 | Ref. | Ref. |
21–50 | 4.58 (1.40–15.01; 0.01) | 2.58 (0.59–11.26; 0.21) |
51–100 | 6.50 (1.71–24.68; 0.01) | 2.43 (0.45–13.19; 0.31) |
> 100 | 2.19 (0.47–10.21; 0.32) | 1.00 (0.17–5.79; 1.00) |
Factors associated with active participation in the DHFA
Univariable OR (95% CI; p) | Multivariable OR (95% CI; p) | |
---|---|---|
Data obtained from the DHFA offers external parties (health insurers, National Health Care Institute) insight into the actual quality of hip fracture care. | 3.19 (1.14–8.95; 0.03) | 3.19 (1.14–8.95; 0.03) |
I am confident that the DHFA working group makes a proper assessment what data (quality indicators) can be made available to external parties. | 2.68 (0.95–7.52; 0.06) | 1.55 (0.48–5.06; 0.47) |
The added value of the DHFA is not clear. | 0.34 (0.12–0.96; 0.04) | 0.44 (0.15–1.28; 0.13) |