Achieving best practice tariff may not reflect improved survival after hip fracture treatment

Achieving best practice tariff may not reflect improved survival after hip fracture treatment

Sameer K Khan,1 Mark DF Shirley,2 Clare Glennie,1 Paul V Fearon,1 David J Deehan1 1The Newcastle upon Tyne Hospitals NHS Foundation Trust, 2School of Biology, Newcastle University, Newcastle upon Tyne, UK Objective: The best practice tariff (BPT) incentivizes hospitals in the England and Wales Nat...

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Autores principales: Khan SK, Shirley MDF, Glennie C, Fearon PV, Deehan DJ
Formato: article
Lenguaje:EN
Publicado: Dove Medical Press 2014
Materias:
Hip fractures
Best Practice Tariff
Mortality
Geriatrics
RC952-954.6
Acceso en línea:https://doaj.org/article/2cc222b8d3334780b1f161ecaa5e091f
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spelling oai:doaj.org-article:2cc222b8d3334780b1f161ecaa5e091f2021-12-02T03:00:14ZAchieving best practice tariff may not reflect improved survival after hip fracture treatment1178-1998https://doaj.org/article/2cc222b8d3334780b1f161ecaa5e091f2014-12-01T00:00:00Zhttps://www.dovepress.com/achieving-best-practice-tariff-may-not-reflect-improved-survival-after-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Sameer K Khan,1 Mark DF Shirley,2 Clare Glennie,1 Paul V Fearon,1 David J Deehan1 1The Newcastle upon Tyne Hospitals NHS Foundation Trust, 2School of Biology, Newcastle University, Newcastle upon Tyne, UK Objective: The best practice tariff (BPT) incentivizes hospitals in the England and Wales National Health Service to provide multiprofessional care to patients with hip fractures. The initial six targets included: 1) admission under consultant-led joint orthopedic–geriatric care, 2) multidisciplinary assessment protocol on admission, 3) surgery within 36 hours, 4) geriatrician review within 72 hours, 5) multiprofessional rehabilitation, and 6) assessment for falls and bone protection. We aimed to examine the relationship between BPT achievement and important patient outcomes and whether the BPT could predict these independently of other validated predictors.Materials and methods: A retrospective review was conducted on 516 patient episodes. Four outcomes were defined: 1) 30-day mortality, 2) 365-day mortality, 3) postoperative length of stay on trauma ward (LOS-T), and 4) total post-operative hospital LOS (LOS-H). Patient episodes were grouped as follows: 1) group 1, pre-BPT, 2) group 2, BPT achievers, 3) group 3, BPT fails. These were compared for mortality (χ2 test) and for LOS (Kruskal–Wallis test). Event analysis was done for groups 2 and 3 using generalized linear modeling, with age, sex, American Society of Anesthesiologists grade, hemoglobin, albumin, creatinine, and BPT achievement evaluated as predictors.Results: The three groups did not differ significantly in baseline characteristics or outcomes. In the event analysis, the risk of 30-day mortality was related only to abnormal creatinine (P=0.025); mortality at 365 days was related significantly to low albumin (P=0.023) and weakly to abnormal creatinine (P=0.089). The risks of both increased LOS-T and LOS-H were related to age only (P=0.052, P<0.001, respectively).Conclusion: Achieving BPT does not predict any outcome of interest on its own. Keywords: hip fractures, best practice tariff, mortalityKhan SKShirley MDFGlennie CFearon PVDeehan DJDove Medical PressarticleHip fracturesBest Practice TariffMortalityGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 9, Pp 2097-2102 (2014)
institution DOAJ
collection DOAJ
language EN
topic Hip fractures
Best Practice Tariff
Mortality
Geriatrics
RC952-954.6
spellingShingle Hip fractures
Best Practice Tariff
Mortality
Geriatrics
RC952-954.6
Khan SK
Shirley MDF
Glennie C
Fearon PV
Deehan DJ
Achieving best practice tariff may not reflect improved survival after hip fracture treatment
description Sameer K Khan,1 Mark DF Shirley,2 Clare Glennie,1 Paul V Fearon,1 David J Deehan1 1The Newcastle upon Tyne Hospitals NHS Foundation Trust, 2School of Biology, Newcastle University, Newcastle upon Tyne, UK Objective: The best practice tariff (BPT) incentivizes hospitals in the England and Wales National Health Service to provide multiprofessional care to patients with hip fractures. The initial six targets included: 1) admission under consultant-led joint orthopedic–geriatric care, 2) multidisciplinary assessment protocol on admission, 3) surgery within 36 hours, 4) geriatrician review within 72 hours, 5) multiprofessional rehabilitation, and 6) assessment for falls and bone protection. We aimed to examine the relationship between BPT achievement and important patient outcomes and whether the BPT could predict these independently of other validated predictors.Materials and methods: A retrospective review was conducted on 516 patient episodes. Four outcomes were defined: 1) 30-day mortality, 2) 365-day mortality, 3) postoperative length of stay on trauma ward (LOS-T), and 4) total post-operative hospital LOS (LOS-H). Patient episodes were grouped as follows: 1) group 1, pre-BPT, 2) group 2, BPT achievers, 3) group 3, BPT fails. These were compared for mortality (χ2 test) and for LOS (Kruskal–Wallis test). Event analysis was done for groups 2 and 3 using generalized linear modeling, with age, sex, American Society of Anesthesiologists grade, hemoglobin, albumin, creatinine, and BPT achievement evaluated as predictors.Results: The three groups did not differ significantly in baseline characteristics or outcomes. In the event analysis, the risk of 30-day mortality was related only to abnormal creatinine (P=0.025); mortality at 365 days was related significantly to low albumin (P=0.023) and weakly to abnormal creatinine (P=0.089). The risks of both increased LOS-T and LOS-H were related to age only (P=0.052, P<0.001, respectively).Conclusion: Achieving BPT does not predict any outcome of interest on its own. Keywords: hip fractures, best practice tariff, mortality
format article
author Khan SK
Shirley MDF
Glennie C
Fearon PV
Deehan DJ
author_facet Khan SK
Shirley MDF
Glennie C
Fearon PV
Deehan DJ
author_sort Khan SK
title Achieving best practice tariff may not reflect improved survival after hip fracture treatment
title_short Achieving best practice tariff may not reflect improved survival after hip fracture treatment
title_full Achieving best practice tariff may not reflect improved survival after hip fracture treatment
title_fullStr Achieving best practice tariff may not reflect improved survival after hip fracture treatment
title_full_unstemmed Achieving best practice tariff may not reflect improved survival after hip fracture treatment
title_sort achieving best practice tariff may not reflect improved survival after hip fracture treatment
publisher Dove Medical Press
publishDate 2014
url https://doaj.org/article/2cc222b8d3334780b1f161ecaa5e091f
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AT fearonpv achievingbestpracticetariffmaynotreflectimprovedsurvivalafterhipfracturetreatment
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