Introduction
Methods
Search strategy
Study selection
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Studies describing (the development of) QIs/performance measures in HF care.
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Studies describing the assessment of the quality of QIs/performance measures in HF care.
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Systematic reviews, meta-analyses, randomized controlled trials, cross-sectional studies, cohort studies, case–control studies, and guidelines on this topic.
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Non-HF care QIs.
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QIs for HF patients below 18 years of age.
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QIs for HF prevention or prehospital HF care.
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Patient reported outcomes measures (PROMs) for HF care.
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Meeting abstracts.
Data extraction
Results
Study selection
Source (see reference list) | Author/audit/guideline name, publication year/start of audit | Country | Study period/year of audit year or guideline | Number of patients in study or audit | Study design or audit/guideline | Quality indicators (process, structure, outcome) |
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[19] | Beringer et al., 2006 | Northern Ireland | 1999–2001 | 2834 | Prospective cohort study | 1. Discharge home within 56 days 2. 30-day mortality |
[20] | Khan et al., 2014 | England | 2008–2011 | 516 | Retrospective cohort study | 1. Time to surgery < 36 h 2. Admitted under joined geriatric/orthopedic care 3. Using an agreed multidisciplinary protocol 4. Assessed by a geriatrician < 72 h 5. Postoperative multi-professional rehabilitation team 6. Fracture prevention assessments (falls/bone health) |
[21] | Kristensen et al., 2016 | Denmark | 2010–2013 | 25,354 | Retrospective cohort study | 1. Daily systematic pain assessment 2. Mobilized within 24 h postoperatively 3. Mobility assessment before admission 4. Mobility assessment at discharge 5. Post-discharge rehabilitation program 6. Future fall prevention 7. Anti-osteoporotic medication |
[22] | Lizaur-Utrilla et al., 2016 | Spain | 2012–2014 | 628 | Prospective cohort study | 1. Surgery within 2 days admission |
[23] | Majumdar et al., 2006 | Canada | 1994–2000 | 3981 | Retrospective cohort study | 1. Surgery within 24 h |
[24] | Merle et al., 2009 | France | 2003–2004 | 857 | Retrospective cohort study | 1. Time to surgery 2. Height and weight mentioned in orthopedic chart 3. Albuminemia mentioned in orthopedic chart 4. Nutritional supplement ordered during stay in orthopedic ward 5. Pressure sore occurrence 6. Time between discharge and completion of orthopedic hospitalization record 7. Time between admission and request for transfer to rehabilitation facility 8. Delay between surgery and first getting up 9. Percentage of in-hospital days with intervention of a physiotherapist 10. Time between surgery and completion of surgery record 11. Patient satisfaction with information about hospital care 12. Patients satisfaction with pain management 13. Time between discharge from rehabilitation ward and completion of rehabilitation hospitalization record 14. Osteoporosis assessment, and/or treatment 15. Prevention of falls initiated |
[25] | Neuburger et al., 2015 | England | 2003–2011 | 471,590 | Retrospective cohort study | 1. Prompt admission to orthopedic care 2. Surgery within 48 h 3. Prevention of pressure ulcers 4. Access to acute orthogeriatric care 5. Assessment for bone protection therapy 6. Falls assessment |
[26] | Currie et al., 2005 | Scotland | 1998–2003 | 30,000 | Retrospective cohort study | 1. No delay in transfer from Accident and Emergency department 2. Surgery performed within 24 h of admission 3. Preoperative care and rehabilitation provided by a multidisciplinary team 4. Standardized data collected for all patients |
[27] | Ferguson et al., 2016 | Scotland | 2003–2008 and 2013 | 31,400 | Retrospective cohort study | 1. Discharge from Accident and Emergency department within 2 h waiting times 2. Surgery within 48 h of admission 3. Length of hospital stay 4. Discharge destination 5. 30-day mortality rate 6. 120-day mortality rate |
[28] | Freeman et al., 2002 | England | 1992 and 1997 | 1478 | Retrospective cohort study | 1. Operation within 48 h of admission 2. Use of prophylactic anticoagulation 3. Mobilization within 48 h of surgery 4. Use of prophylactic antibiotics 5. Seen by a geriatrician 6. Standard risk assessment for pressure sores on admission to orthopedic ward 7. 3 months’ little or no hip pain 8. 3 months’ return to pre-fracture activities of daily living 9. 3 months’ return to pre-fracture level of accommodation 10. 3 months’ mortality rate 11. 3 months pneumonia rate 12. 3 months’ pulmonary embolism rate 13. 3 months’ myocardial infarction rate 14. 3 months’ wound and hip joint infection rate 15. 3 months’ pressure sore grade II or worse |
[29] | Holly et al., 2014 | United States | – | – | Systematic review | 1. Assessment for delirium risk factors using a valid and reliable tool 2. The environment is assessed daily for preventive strategies to maintaining sensory orientation 3. Receive essential nursing care 4. Appropriate clinical criteria applied to confirm diagnosis of delirium 5. Non-pharmacologic interventions employed before pharmacologic interventions in patients with a diagnosis of delirium |
[30] | Khan et al., 2013 | England | 2010–2011 versus 2011–2012 | 873 | Retrospective cohort study | 1. Time to surgery <36 h 2. Admitted under joined geriatric/orthopedic care 3. Using an agreed multidisciplinary protocol 4. Assessed by a geriatrician <72 h 5. Post-operative multi-professional rehabilitation team 6. Fracture prevention assessments (falls/bone health) |
[31] | Patel et al., 2013 | England | 2009–2010 | 372 | Retrospective cohort study | 1. Time to surgery < 36 h 2. Admitted under joined geriatric/orthopedic care 3. Using an agreed multidisciplinary protocol 4. Assessed by a geriatrician < 72 h 5. Postoperative multi-professional rehabilitation team 6. Fracture prevention assessments (falls/bone health) |
[32] | Sund et al., 2005 | Finland | 1998–2001 | 16,881 | Retrospective cohort study | 1. Time to surgery within 48 h from arrival upon start of operation |
[33] | Nielsen et al., 2009 | Denmark | 2005–2006 | 6266 | Retrospective cohort study | 1. Early assessment of nutritional risk 2. Systematic pain assessment during mobilization 3. Assessment of Activities of Daily Living (ADL) before fracture 4. Assessment of Activities of Daily Living (ADL) before discharge 5. Treatment to prevent future osteoporotic fractures |
[34] | Siu et al., 2006 | United States | 1997–1998 | 554 | Prospective cohort study | 1. Time from admission to surgery 2. Abnormal clinical findings before surgery (laboratory tests) 3. Start of anticoagulation to prevent thromboembolism 4. Anticoagulation regimen 5. Use of prophylactic antibiotics 6. Removal of urinary catheter postoperatively 7. Mobilization to a chair in first 3 postoperative days 8. Mobilization beyond chair in first 3 postoperative days 9. Physical therapy in first 3 postoperative days 10. Days of moderate or severe pain over first 5 hospital days 11. Number of days of severe pain with no or only slight relief 12. Avoidance of restraints 13. Stability at discharge (unresolved active clinical issues) |
[35] | National Hip Fracture Database, 2007 | England | 2016 | 64,864 | Audit | 1. Surgery on the day of, or the day after, admission 2. Pain assessment upon presentation at hospital 3. Administration of nerve blocks if no preoperative pain control 4. Offer a choice of spinal or general anesthesia 5. Intraoperative nerve blocks for all patients undergoing surgery 6. Hip fracture surgery scheduled on a planned trauma list 7. Consultants or senior staff supervise trainee of the anesthesia, surgical, and theater teams 8. Arthroplasty in a displaced intracapsular fracture 9. Total hip replacement in defined conditions1 10. Cemented implants with arthroplasty 11. Extramedullary implants in AO classification types A1 and A2 12. IM nail in case of a subtrochanteric fracture 13. Physiotherapy assessment and mobilization on the day after surgery 14. Hip Fracture Program during admission2 15. If a hip fracture complicates or precipitates a terminal illness, consider surgery as part of a palliative care approach 16. Early supported discharge as part of the HFP2 17. Intermediate care in certain conditions3 18. Patients admitted from care or nursing homes should not be excluded from community or hospital rehabilitation programs 19. Patients offered verbal and printed information about treatment and care 20. All inpatients and outpatients at their first clinic appointment screened for malnutrition 21. Minimize risk of delirium by actively looking for cognitive impairment and reassessing patients to identify a delirium 22. Multidisciplinary assessment of future risk and individualized intervention to prevent falls 23. Strength and balance training 24. Bisphosphonates in postmenopausal women with osteoporosis |
[36] | Scottish Hip Fracture Audit, 1993–2008, restart 2015 | Scotland | 2016 | 1041 | Audit | 1. Transfer from the Emergency Department to the Orthopedic ward within 4 h 2. The “Big Six” interventions/treatments applied before leaving the Emergency Department4 3. “Inpatient Bundle of Care” within 24 h of admission5 4. Surgical repair within 36 h of admission 5. No repeated fasting in preparation for surgery 6. Preoperative catheterization only for medical reasons 7. Cemented hemi-arthroplasty implants 8. Frail patients have a geriatric assessment within 3 days of admission 9. Mobilization on the first day after surgery and physiotherapy assessment by end of day 2 10. Occupational therapy assessment by the end of day 3 postoperatively 11. Assessment of bone health prior to leaving the acute orthopedic ward 12. Discharge back to original place of residence within 30 days from the date of admission |
[37] | Australian and New Zealand Hip Fracture Registry (ANZHFR), 2013 | Australia and New Zealand | 2016 | 3519 | Audit/guideline | 1a: Local arrangements for the management of hip fracture patients in the emergency department. 1b: Preoperative cognitive status assessment 2a: Local arrangements for pain management 2b: Assessment of pain within 30 min of arrival 3: Orthogeriatric management during admission 4: Surgery within 48 h of presentation 5a: Mobilized on day one post hip fracture surgery 5b: Unrestricted weight-bearing status immediately after hip fracture surgery 5c: Stage II or higher pressure ulcer during their hospital stay. 5d: Returning to pre-fracture mobility 6a: Bone protection medicine before discharge 6b: Readmissions with another femoral fracture within 12 months of admission from initial hip fracture 7a: Local arrangements for the development of an individualized care plan 7b: Proportion returning to private residence within 120 days after discharge from hospital 8a: Re-operation of hip fracture patients within 30-days 8b: Survival at 30 days post-admission |
[38] | Rikshöft, 1988* | Sweden | 2016 | 15,062 | Audit | 1. Operation within 24 h 2. Dislocated fractures operated with arthroplasty 3. Pain measurement 4. Pressure ulcer measurement 5. Patients going directly home and patients back home after 4 months |
[39] | Dutch Hip Fracture Audit (DHFA), 2016 | The Netherlands | 2016 | 19,000 avg/year | Audit | 1. Participation in the DHFA 2. Functional outcomes scores registered at admission and 3 months after admission |
[40] | Irish Hip Fracture Database (IHFD) | Ireland | 2016 | 3159 | Audit | 1. Prompt admission to orthopedic care 2. Surgery within 48 h 3. Prevention of pressure ulcers 4. Access to acute orthogeriatric care 5. Assessment for bone protection therapy 6. Falls assessment |
[41] | Kaiser Permanente National Implant Registries, 2009** | United States | 2015 | 29,414 | Audit | 1. Time to surgery 2. Time to surgery > 48 h 3. Length of in-patient stay 4. 30-day emergency visit 5. 30-day inpatient readmission 6. 90-day revision 7. 90-day mortality |
[42] | Danish Multidisciplinary Hip Fracture Registry (DMHFR), 2013 | Denmark | 2016 | 6789 | Audit | 1. Assessment within 4 h by a specialist 2a. Operated within 24 h 2b. Operated within 36 h 3. Mobilized within 24 h after operation 4a. Functional assessment before fracture 4b. Functional assessment with discharge 5. Dietary advice 6. Bone health assessment 7. Start of anticoagulation to prevent thromboembolism 8. 30-day mortality rate 9. Rehabilitation plan before discharge 10. Readmission within 30-days 11a. Reoperation rate within 2 years of collum fractures operated with osteosynthesis 11b. Reoperation rate within 2 years of non-dislocated collum fractures operated with osteosynthesis 11c. Reoperation rate within 2 years of dislocated collum fractures operated with osteosynthesis 12. Reoperation rate within 2 years of trochanteric fractures operated with osteosynthesis 13. Reoperation rate within 2 years after total or hemi-arthroplasty 14. Reoperation rate within 2 years due to deep wound infection |
National Institute for Health and Care Excellence. The management of hip fracture in adults (CG124). Distracted from the guideline: – Hip fracture in Adults: Quality standard 16 (1–6) – British Orthopaedic Association Standards for Trauma (5–17) | UK | 2011, updated 2017 | – | Guideline | 1. Total hip replacement in defined conditions 1 2. Extramedullary implants in AO classification types A1 and A2 3. IM nail in case of a subtrochanteric fracture 4. Rehabilitation once a day, started no later than the day after surgery. 5. Hip Fracture Program during admission2 6. Surgery on the day of, or day after, admission 7. Anti-osteoporosis therapy and fall assessment 8. Orthogeriatric management 9. Patients unable to bear weight with negative X-rays should be offered a MRI 10. Immediate analgesia on presentation and in case of pain. 11. Treat correctable comorbidities immediately 12. Direct weight-bearing mobilization with physiotherapist postoperative 13. Assess risk of delirium and dementia 14. Consider surgery as palliative treatment 15. Assessment and treatment of thromboembolism and pressure sore 16. Printed and verbal information on treatment and rehabilitation 17. Data submission to the NHFD | |
[45] | National Hip Fracture Toolkit | Canada | 2011 | – | Guideline | 1. Surgery within 24 h 2. Surgery within 48 h 3. Total operation time 4. Intra-operative adverse events 5. Length of stay 6. Discharge destination 7. In hospital mortality 8. Mortality at 1 year 9. Not discharged to pre-fracture living conditions 10. Admissions to long-term care in 6 months 11. Refracture 1 year post-surgery |
Websites of ongoing hip fracture audits
Hip fracture guidelines
Identified quality indicators
Structure quality indicator* | Source (see reference list) | Outcome measure used to correlate to indicator** | Correlation with outcome present (P), not present (NP), not tested individually (NTI), and source (see reference list) |
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1. Orthogeriatric management during admission | 2, 3, 4, 5, 12, 13, 15 | ||
2. Using an agreed multidisciplinary protocol | 3, 4, 5, 12, 13, 15 | ||
3. Hip fracture surgery planned on a trauma list | [35] | 1, 3, 5, 6, 7, 8, 9, 11, 13, 14 | NTI for all outcome measures [35] |
4. Postoperative multi-professional rehabilitation team | 3, 4, 5, 12, 13, 15 | ||
5. Post-discharge rehabilitation program | 5, 10, 13 | P: 13 [21] NP: 5, 10 [21] | |
6. Appropriate clinical criteria are applied to confirm a diagnosis of delirium | [29] | – | – |
7. Consultants or senior staff supervise trainee of the anesthesia, surgical, and theater teams | [35] | 1, 3, 5, 6, 7, 8, 9, 11, 13, 14 | NTI for all outcome measures [35] |
8. Patients are offered verbal and printed information about treatment and care | 1, 3, 5, 6, 7, 8, 9, 11, 13, 14 | NTI for all outcome measures [35] | |
9. Participation in nationwide Hip Fracture Audit | – | – |
Process quality indicator* | Source (see reference list) | Outcome measure used to correlate to indicator** | Correlation with outcome present (P), not present (NP), not tested individually (NTI), and source (see reference list) |
---|---|---|---|
1. Patients unable to bear weight with negative X-rays should be offered a MRI | [44] | – | – |
2. Prompt admission to orthopedic care | 2, 26 | NTI for all outcome measures [25] | |
3. The “Big Six†” interventions/treatments must be done before leaving the emergency department | [36] | – | – |
4. Transfer from the accident and emergency department within a specific time frame | – | – | |
5. Treat correctable comorbidities immediately | [44] | – | – |
6. Assessed by a geriatrician within specific time frame | 3, 4, 5, 25, 26, 30 | ||
7. Assessment by a specialist within 4 h | [42] | – | – |
8. The “Inpatient Bundle of Care§” must be provided within 24 h of admission | [36] | – | – |
9. Preoperative cognitive status assessment | – | – | |
10. Preoperative catheterization only for medical reasons | [36] | – | – |
11. Abnormal clinical findings before surgery | [34] | 12, 21, 22, 29 | P: – NP: 12, 21, 22, 29 [34] |
12. Immediate analgesia on presentation and in case of pain | [44] | – | – |
13. Add nerve blocks if no preoperative pain control | [35] | 1, 3, 5, 6, 8, 13, 15, 17, 26, 27 | NTI for all outcome measures [35] |
14. Offer a choice of spinal or general anesthesia | [35] | 1, 3, 5, 6, 8, 13, 15, 17, 26, 27 | NTI for all outcome measures [35] |
15. Use of prophylactic antibiotics | 12, 21, 22, 29 | P: – NP: 12, 21, 22, 29 [34] | |
16. No patients should be repeatedly fasted in preparation for surgery | [36] | – | – |
17. Time to surgery within a specific time frame | 1, 2, 3, 4, 5, 6, 7, 8, 11, 12, 13, 15, 16, 17, 19, 20, 21, 22, 25, 26, 27, 28, 29, 30 | ||
18. Total operation time | [45] | – | – |
19. Consider intraoperative nerve blocks for all patients undergoing surgery | [35] | 1, 3, 5, 6, 8, 13, 15, 17, 26, 27 | NTI for all outcome measures [35] |
20. Mobilized within specific time after surgery | 1, 3, 5, 6, 7, 8, 10, 11, 13, 15, 16, 17, 19, 20, 26, 27, 28 | NP: – | |
21. Postoperative physical therapy | 5, 11, 12, 16, 20, 21, 22, 28, 29 | P: – NP: 12, 21, 22, 29 [34] NTI: 5, 11, 16, 20, 28 [24] | |
22. Unrestricted weight-bearing status immediately postoperative | – | – | |
23. Percentage of days with intervention of a physiotherapist | [24] | 5, 11, 16, 20, 28 | NTI for all outcome measures [24] |
24. Mobilization to a chair in first 3 postoperative days | [34] | 12, 21, 22, 29 | P: – NP: 12, 21, 22, 29 [34] |
25. Mobilization beyond chair in first 3 postoperative days | [34] | 12, 21, 22, 29 | P: – NP: 12, 21, 22, 29 [34] NTI: – |
26. Strength and balance training | [35] | 1, 3, 5, 6, 8, 13, 15, 17, 26, 27 | NTI for all outcome measures [35] |
27. Mobility assessment before admission | [21] | 5, 10, 26 | P: – NP: 5, 10, 26 [21] |
28. Mobility assessment at discharge | [21] | 5, 10, 26 | P: – NP: 5, 10, 26 [21] |
29. Fracture-prevention assessment (fall/bone health) | 1, 2, 3, 4, 5, 6, 8, 10, 11, 13, 15, 16, 17, 20, 25, 26, 27, 28, 30 | NP: 5, 26 [21] | |
30. Bisphosphonates in postmenopausal women who have osteoporosis | [35] | 1, 3, 5, 6, 8, 13, 15, 17, 26, 27 | NTI for all outcome measures [35] |
31. Systematic pain assessment | 1, 3, 5, 6, 8, 10, 13, 15, 17, 26, 27 | NP: 5, 26 [21] NTI: 1, 3, 5, 6, 8, 13, 15, 17, 26, 27 [35] | |
32. Assessment of malnutrition | 1, 3, 5, 6, 8, 11, 13, 15, 16, 17, 20, 26, 27, 28 | P: – NP: 26 [33] | |
33. Prevention/assessment of pressure ulcer | 2, 26 | NTI for all outcome measures [25] | |
34. Occupational therapy (OT) assessment by the end of day 3 postoperatively | [36] | – | – |
35. Assessment and treatment of thromboembolism and pressure sore | [44] | – | – |
36. All elderly are assessed daily for delirium risk factors using a valid and reliable tool | 1, 3, 5, 6, 8, 13, 15, 17, 26, 27 | NTI for all outcome measures [35] | |
37. Assessment of Activities of Daily Living (ADL) before fracture | 26 | P: 26 [33] NP: – | |
38. Assessment of Activities of Daily Living (ADL) before discharge | [33] | 26 | P: 26 [33] NP: – |
39. Use of anticoagulation to prevent thromboembolism | 12, 21, 22, 29 | P: – NP: 12, 21, 22, 29 [34] | |
40. Type of anticoagulation regimen | [34] | 12, 21, 22, 29 | P: – NP: 12, 21, 22, 29 [34] |
41. The environment of hip fracture patients is assessed daily for preventive strategies to maintain sensory orientation | [29] | – | – |
42. Non-pharmacologic interventions are employed before pharmacologic interventions in patients with a delirium | [29] | – | – |
43. Removal of urinary catheter postoperatively | [34] | 12, 21, 22, 29 | P: – NP: 12, 21, 22, 29 [34] |
44. Avoidance of restrains | [34] | 12, 21, 22, 29 | P: – NP: 12, 21, 22, 29 [34] |
45. Time between discharge and complementation of orthopedic hospitalization record | [24] | 5, 11, 16, 20, 28 | NTI for all outcome measures [24] |
46. Time between surgery and completion of surgery record | [24] | 5, 11, 16, 20, 28 | NTI for all outcome measures [24] |
47. Time between discharge from rehabilitation ward and completion of rehabilitation hospitalization record | [24] | 5, 11, 16, 20, 28 | NTI for all outcome measures [24] |
48. Height and weight mentioned in orthopedic chart | [24] | 5, 11, 16, 20, 28 | NTI for all outcome measures [24] |
49. Albuminemia mentioned in orthopedic chart | [24] | 5, 11, 16, 20, 28 | NTI for all outcome measures [24] |
50.Time between admission and request of place in rehabilitation facility | [24] | 5, 11, 16, 20, 28 | NTI for all outcome measures [24] |
51. Stability at discharge (unresolved active clinical issues) | [34] | 12, 21, 22, 29 | P: – NP: 12, 21, 22, 29 [34] |
52. Cemented implants with arthroplasty | 1, 3, 5, 6, 8, 13, 15, 17, 26, 27 | NTI for all outcome measures [35] | |
53. Arthroplasty in a displaced intracapsular fracture | 1, 3, 5, 6, 8, 13, 15, 17, 26, 27 | NTI for all outcome measures [35] | |
54. Total hip replacement in defined conditions | 1, 3, 5, 6, 8, 13, 15, 17, 23, 24 26, 27 | P: 23, 24 [43] NP: – NTI 1, 3, 5, 6, 8, 13, 15, 17, 26, 27 [35] | |
55. Extramedullary implants in AO classification types A1 and A2 | 1, 3, 5, 6, 8, 13, 14, 15, 17, 26, 27 | P: 14 [43] NP: – NTI: 1, 3, 5, 6, 8, 13, 15, 17, 26, 27 [35] | |
56. IM nail with a subtrochanteric fracture | 1, 3, 5, 6, 8, 9, 13, 15, 17, 26, 27 | P: 9 [43] NP: – NTI: 1, 3, 5, 6, 8, 13, 15, 17, 26, 27 [35] | |
57. Hip Fracture Program¶ during admission | 1, 3, 5, 6, 8, 13, 15, 17, 23, 25, 26, 27 | P: 23, 25 [43] NP: – NTI: 1, 3, 5, 6, 8, 13, 15, 17, 26, 27 [35] | |
58. If a hip fracture complicates or precipitates a terminal illness, consider surgery as part of a palliative care approach | 1, 3, 5, 6, 8, 13, 15, 17, 26, 27 | NTI for all outcome measures [35] | |
59. Consider early supported discharge as part of the HFP¶ | [35] | 1, 3, 5, 6, 8, 13, 15, 17, 26, 27 | NTI for all outcome measures [35] |
60. Only consider intermediate care in certain conditions | [35] | 1, 3, 5, 6, 8, 13, 15, 17, 26, 27 | NTI for all outcome measures [35] |
61. Patients admitted from care or nursing homes should not be excluded from community or hospital rehabilitation programs | [35] | 1, 3, 5, 6, 8, 13, 15, 17, 26, 27 | NTI for all outcome measures [35] |
62. Rehabilitation plan before discharge | [42] | – | – |
63. Functional outcomes scores registered at admission and 3 months after admission | [39] | – | – |
Outcome quality indicator* | Source (see reference list) |
---|---|
1. Short-term mortality rate* | |
2. Long-term mortality rate* | |
3. Short-term reoperation rate* | [37] |
4. Long-term reoperation rate* | |
5. Intraoperative adverse events | [45] |
6. Pressure sore occurrence | |
7. Discharge destination | |
8. Back to original place of residence within specific time frame | |
9. Short-term emergency visit* | [41] |
10. Short-term readmissions rate* | |
11. Readmissions with another femoral fracture within 12 months of admission from initial hip fracture | |
12. Admissions to long-term care in 6 months | [45] |
13. Days of moderate or severe pain over first 5 hospital days | [34] |
14. Number of days of severe pain with no or only slight relief | [34] |
15. Little or no hip pain 3 months after surgery | [28] |
16. Patient satisfaction with pain management | [24] |
17. Patient satisfaction with information about hospital care | [24] |
18. Returning to pre-fracture mobility | [37] |
19. Return to pre-fracture activities of daily living after 3 months | [28] |
20. Length of hospital stay | |
21. Pneumonia rate after 3 months | [28] |
22. Pulmonary embolism rate after 3 months | [28] |
23. Myocardial infarction rate after 3 months | [28] |
24. Wound and hip joint infections rate after 3 months | [28] |
25. All patients with a hip fracture receive essential nursing care | [29] |
Quality of the QIs
Selected set of quality indicators for a hip fracture audit
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Orthogeriatric management during admission (structure indicator, correlation with outcome not tested)
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Time to surgery (process indicator, correlated with 1-year mortality)
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Time to mobilization after surgery (process indicator, correlated with length of stay, 30-day readmission, and 30-day mortality)
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Future fracture prevention assessment (process indicator, correlated with 30-day readmission and 30-day mortality rate)
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Systematic pain assessment (process indicator, correlated with 30-day readmission and 30-day mortality rate)
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Assessment of malnutrition (process indicator, no correlation with outcome found)
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Prevention/assessment of pressure ulcer (process indicator, no correlation with outcome found)
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Mortality rate (outcome indicator)
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Return to the place of residence within a specific time frame (outcome indicator)