There are significant differences in healthcare spending and care delivery across NHS hospitals in England and Wales after hip fracture, a new study aimed at understanding how hospital care affects patient outcomes and costs has revealed.
The study, led by the University of Bristol and funded by Versus Arthritis, highlights the urgent need for evidence-based quality improvement strategies to reduce healthcare spending and improve patient outcomes in the year following a hip fracture. The research has been published online at Healthy Longevity Lancet today [10 July].
Hip fracture is a serious health concern, with more than 70,000 elderly people being admitted to hospital in the UK each year. This study highlights the high healthcare burden associated with hip fracture.
The research analyzed data from national databases for 178,757 hip fracture patients aged 60 and over in England and Wales, who fractured their hip between 2016 and 2019, and followed them up just before the epidemic. More than one in four patients died within a year of suffering a hip fracture.
Patients spent an average of 32 days in hospital in the year following a hip fracture, resulting in significant inpatient costs averaging £14,642 per patient – a cost comparable to that incurred in the year following a stroke, and this exceeds Costs for multiple co-patients. crabs. But this cost varied widely between hospitals, with a difference in spending more than twofold, ranging from £10,867 to £23,188 per patient, among the NHS hospitals studied in England and Wales.
The researchers determined that in hospitals where patients were awake and fast after surgery and where physical therapy was provided seven days a week, patient costs were lower, the risk of sudden confusion (delirium) decreased, and patients spent fewer days in the hospital in the year following a hip fracture.
The research also highlights the critical role of orthopedists – consultant geriatrics who specialize in the care of people with fractures – in the care of hip fractures.
The results show that having all patients assessed by an orthopedic specialist within the first days of admission could reduce healthcare spending by £529 per patient, as well as reduce the chance of death by 15% in the year following a hip fracture.”
Dr Petra Bagge, Senior Research Associate in Health Economics at Bristol Medical School: Translational Health Sciences (THS) and first author of the paper
Dr Rita Patel, senior research medical statistician at Bristol and study statistician, added: ‘If a consultant orthopedic surgeon attended hospital clinical governance meetings, an additional cost saving of £356 could potentially be achieved, as well as patients spending fewer days spent in hospital. The following year he broke his hip.
The study highlights the importance of addressing the way hospitals deliver hip fracture care to improve the effectiveness and efficiency of hip fracture services, and the need to develop evidence-based quality improvement strategies across the UK, to achieve financial savings while also improving patient outcomes.
Celia Gregson, Professor of Clinical Epidemiology in the University of Bristol’s Musculoskeletal Research Unit and lead author on the study, commented, “The discrepancy we saw in patient outcomes and health expenditure after hip fracture is difficult to justify on purely clinical grounds, telling us that the way we organize the delivery of care can improve it at the national level.
“By prioritizing assessment by orthopedists, getting patients out of bed promptly after surgery, providing seven days of physical therapy, reducing the risk of delirium for patients, and holding monthly multidisciplinary clinical governance meetings, hospitals are improving patient outcomes and reducing their healthcare spending.” .”
Caroline Ailot, Head of Research Delivery vs Arthritis, said: “This research shows the unacceptable state of care for older adults with a hip fracture. The findings show that older adults have a high chance of dying within a year of a hip fracture, and quality of care varies widely. Among NHS hospitals in England and Wales.
“Because hip fractures mainly affect older people, many of whom live with multiple long-term conditions, this research suggests that we are not getting the right care for older people. That needs to change.
“The study finds that better and faster access to orthopedic doctors and fracture contact services will not only reduce people’s risk of dying and improve their chances of a better recovery, but also reduce NHS spending. Just weeks after the publication of the NHS Workforce Scheme, the study provides yet more evidence of the need. dire and immediate to the appropriately resourced NHS.”
The research team has already developed a potential solution, after working with the Royal Osteoporosis Society to develop an innovative toolkit – the Hip Fracture Service Implementation Kit – supported by the findings of their research.
The toolkit is available free of charge to all healthcare professionals and service managers to support the improvement of the quality of fracture service delivery within 172 acute hospital settings across England and Wales.
This study follows on from previous work from the REDUCE (Reducing Unexplained Variation in Provision of High-Quality Hip Immobilization Services in England and Wales) study, published last year in Age and agingJournal of the British Geriatrics Society, which focused on patient outcomes for hip fracture patients in the short term.
The study was funded by Versus Arthritis (ref: 22086), the UK’s largest charity supporting people with arthritis and diseases of the musculoskeletal system, and with support from the National Institute for Healthcare Research and the Bristol Biomedical Research Center (NIHR Bristol BRC).
[ad_2]