An Sermon1,2, Cedric Slock1, Ellen Coeckelberghs3,4, Deborah Seys3, Massimiliano Panella4,5, Luk Bruyneel3, Stefaan Nijs1, Alain Akiki6, Pablo Castillon7,8, Alex Chipperfield9, René El Attal10, Nicolai Bang Foss11, Frede Frihagen12,13, Torsten G Gerich14, Denis Gümbel15,16, Nikolaos Kanakaris17, Morten Tange Kristensen18,19, Inger Malchau20, Henrik Palm21, Hans-Christoph Pape22, Kris Vanhaecht23,24,25. 1. KU Leuven, Leuven, Belgium. 2. Traumatology Department at University Hospitals Leuven, Leuven, Belgium. 3. Leuven Institute for Healthcare Policy, Leuven, KU, Belgium. 4. European Pathway Association, Leuven, Belgium. 5. Università Degli Studi del Piemonte Orientale "Amedeo Avogadro", Novara, Italy. 6. Hôpital Riviera Chablais, Rennaz, Switzerland. 7. Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España. 8. Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, España. 9. Consultant Trauma and Orthopaedic Surgeon, East Kent Hospitals NHS Trust, Kent, UK. 10. Klinik für Orthopädie und Unfallchirurgie, Sporttraumatologie, Landeskrankenhaus Feldkirch, Feldkirch, Austria. 11. Departments of Anaesthesia and Intensive Care, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. 12. Orthopaedic Department, Østfold Hospital Trust, Grålum, Norway. 13. Associate Professor, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 14. Head of Orthopaedic Trauma, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg. 15. Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany. 16. Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany. 17. Leeds Major Trauma Centre, Leeds Teaching Hospitals NHS Trust, Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds, UK. 18. Departments of Physiotherapy and Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark. 19. Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. 20. Sahlgrenska University Hospital, Gothenburg, Sweden. 21. Head of Department, Department of Orthopedics, Copenhagen University Hospital Bispebjerg, Bispebjerg, Denmark. 22. Department of Trauma, University of Zurich, Universitäts Spital Zurich, Zurich, Switzerland. 23. Leuven Institute for Healthcare Policy, Leuven, KU, Belgium. kris.vanhaecht@kuleuven.be. 24. European Pathway Association, Leuven, Belgium. kris.vanhaecht@kuleuven.be. 25. Department of Quality, University Hospitals Leuven, Leuven, Belgium. kris.vanhaecht@kuleuven.be.
Abstract
PURPOSE: Even though hip fracture care pathways have evolved, mortality rates have not improved during the last 20 years. This finding together with the increased frailty of hip fracture patients turned hip fractures into a major public health concern. The corresponding development of an indicator labyrinth for hip fractures and the ongoing practice variance in Europe call for a list of benchmarking indicators that allow for quality improvement initiatives for the rapid recovery of fragile hip fractures (RR-FHF). The purpose of this study was to identify quality indicators that assess the quality of in-hospital care for rapid recovery of fragile hip fracture (RR-FHF). METHODS: A literature search and guideline selection was conducted to identify recommendations for RR-FHF. Recommendations were categorized as potential structure, process, and outcome QIs and subdivided in-hospital care treatment topics. A list of structure and process recommendations that belongs to care treatment topics relevant for RR-FHF was used to facilitate extraction of recommendations during a 2-day consensus meeting with experts (n = 15) in hip fracture care across Europe. Participants were instructed to select 5 key recommendations relevant for RR-FHF for each part of the in-hospital care pathway: pre-, intra-, and postoperative care. RESULTS: In total, 37 potential QIs for RR-FHF were selected based on a methodology using the combination of high levels of evidence and expert opinion. The set consists of 14 process, 13 structure, and 10 outcome indicators that cover the whole perioperative process of fragile hip fracture care. CONCLUSION: We suggest the QIs for RR-FHF to be practice tested and adapted to allow for intra-hospital longitudinal follow-up of the quality of care and for inter-hospital and cross-country benchmarking and quality improvement initiatives.
PURPOSE: Even though hip fracture care pathways have evolved, mortality rates have not improved during the last 20 years. This finding together with the increased frailty of hip fracture patients turned hip fractures into a major public health concern. The corresponding development of an indicator labyrinth for hip fractures and the ongoing practice variance in Europe call for a list of benchmarking indicators that allow for quality improvement initiatives for the rapid recovery of fragile hip fractures (RR-FHF). The purpose of this study was to identify quality indicators that assess the quality of in-hospital care for rapid recovery of fragile hip fracture (RR-FHF). METHODS: A literature search and guideline selection was conducted to identify recommendations for RR-FHF. Recommendations were categorized as potential structure, process, and outcome QIs and subdivided in-hospital care treatment topics. A list of structure and process recommendations that belongs to care treatment topics relevant for RR-FHF was used to facilitate extraction of recommendations during a 2-day consensus meeting with experts (n = 15) in hip fracture care across Europe. Participants were instructed to select 5 key recommendations relevant for RR-FHF for each part of the in-hospital care pathway: pre-, intra-, and postoperative care. RESULTS: In total, 37 potential QIs for RR-FHF were selected based on a methodology using the combination of high levels of evidence and expert opinion. The set consists of 14 process, 13 structure, and 10 outcome indicators that cover the whole perioperative process of fragile hip fracture care. CONCLUSION: We suggest the QIs for RR-FHF to be practice tested and adapted to allow for intra-hospital longitudinal follow-up of the quality of care and for inter-hospital and cross-country benchmarking and quality improvement initiatives.
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