Deborah Seys1, An Sermon2,3, Walter Sermeus1, Massimiliano Panella1,4, Luk Bruyneel1,5, Paulo Boto6, Kris Vanhaecht7,8. 1. Department of Public Health and Primary Care, KU Leuven-University of Leuven, Kapucijnenvoer 35/7001, 3000, Leuven, Belgium. 2. Department of Development and Regeneration, KU Leuven-University of Leuven, Herestraat 49, 3000, Leuven, Belgium. 3. Department of Traumatology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. 4. Department of Translational Medicine, University of Eastern Piedmont "A. Avogadro", Via Solaroli 17, 28100, Novara Piedmont, Italy. 5. Department of Quality Management, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. 6. Department of Health Services Policy and Management Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP), Universidade Nova de Lisboa (UNL), Av. Padre Cruz, 1600-560, Lisbon, Portugal. 7. Department of Public Health and Primary Care, KU Leuven-University of Leuven, Kapucijnenvoer 35/7001, 3000, Leuven, Belgium. kris.vanhaecht@kuleuven.be. 8. Department of Quality Management, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. kris.vanhaecht@kuleuven.be.
Abstract
INTRODUCTION: Despite the availability of clinical guidelines on the prevention and treatment of geriatric hip fractures, the percentage of recommended care received by patients is low. We conducted an importance-performance analysis for prioritizing interventions to improve the in-hospital management of these patients. MATERIALS AND METHODS: A secondary data analysis was conducted on the in-hospital treatment of 540 geriatric hip fracture patients in 34 hospitals in Belgium, Italy, and Portugal. First, we assessed the level of expert consensus on the process indicators composing international guidelines on hip fracture treatment. Second, guideline adherence on in-hospital care was evaluated within and across hospitals. Third, an importance-performance analysis was conducted, linking expert consensus to guideline adherence. RESULTS: Level of expert consensus was high (above 75%) for 12 of 22 process indicators identified from the literature. There is large between and within hospital variation in guideline adherence for these indicators and for none of the 540 patients were all 22 process indicators adhered to. Importance-performance analysis demonstrated that three indicators that had a high level of expert consensus also had a high level of adherence (above 80%). Nine indicators, most of which have been previously linked to patient outcomes, had a high level of expert consensus but a consistently low level of adherence across hospitals and are identified as priority areas for improvement. CONCLUSIONS: Guideline adherence for the treatment of geriatric hip fracture patients is remarkably suboptimal. Importance-performance analysis is a useful strategic approach to assist practitioners and healthcare managers to improve the quality of care.
INTRODUCTION: Despite the availability of clinical guidelines on the prevention and treatment of geriatric hip fractures, the percentage of recommended care received by patients is low. We conducted an importance-performance analysis for prioritizing interventions to improve the in-hospital management of these patients. MATERIALS AND METHODS: A secondary data analysis was conducted on the in-hospital treatment of 540 geriatric hip fracturepatients in 34 hospitals in Belgium, Italy, and Portugal. First, we assessed the level of expert consensus on the process indicators composing international guidelines on hip fracture treatment. Second, guideline adherence on in-hospital care was evaluated within and across hospitals. Third, an importance-performance analysis was conducted, linking expert consensus to guideline adherence. RESULTS: Level of expert consensus was high (above 75%) for 12 of 22 process indicators identified from the literature. There is large between and within hospital variation in guideline adherence for these indicators and for none of the 540 patients were all 22 process indicators adhered to. Importance-performance analysis demonstrated that three indicators that had a high level of expert consensus also had a high level of adherence (above 80%). Nine indicators, most of which have been previously linked to patient outcomes, had a high level of expert consensus but a consistently low level of adherence across hospitals and are identified as priority areas for improvement. CONCLUSIONS: Guideline adherence for the treatment of geriatric hip fracturepatients is remarkably suboptimal. Importance-performance analysis is a useful strategic approach to assist practitioners and healthcare managers to improve the quality of care.
Entities:
Keywords:
Adherence to guidelines; Hip fracture; Importance–performance analysis; Level of expert consensus; Quality of care
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