Patricia Ysabel Condorhuamán-Alvarado1,2, Teresa Pareja-Sierra3, Angélica Muñoz-Pascual4, Pilar Sáez-López5,6,7, Jesús Diez-Sebastián8, Cristina Ojeda-Thies9, Alicia Gutiérrez-Misis10,11, Teresa Alarcón-Alarcón12,5,13, María Concepción Cassinello-Ogea14, Jose Luis Pérez-Castrillón15, Paloma Gómez-Campelo5,16, Laura Navarro-Castellanos5,17, Ángel Otero-Puime5,18, Juan Ignacio González-Montalvo12,5,13. 1. Department of Geriatrics, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain. patricia.condorhuaman@salud.madrid.org. 2. Hospital La Paz Institute for Health Research - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain. patricia.condorhuaman@salud.madrid.org. 3. Department of Geriatrics, Hospital Universitario Guadalajara, Guadalajara, Spain. 4. Department of Geriatrics, Hospital General de Segovia, Segovia, Spain. 5. Hospital La Paz Institute for Health Research - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain. 6. Geriatric Medicine Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain. 7. Head Coordinator of the Spanish National Hip Fracture Registry, Madrid, Spain. 8. Clinical Epidemiology Unit, Department of Preventive Medicine, Hospital Universitario La Paz, Madrid, Spain. 9. Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain. 10. Hospital La Paz Institute for Health Research - IdiPAZ, Hospital Universitario La Paz - Universidad Autónoma de Madrid, Madrid, Spain. alicia.gutierrezm@uam.es. 11. Medicine Department, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain. alicia.gutierrezm@uam.es. 12. Department of Geriatrics, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain. 13. Medicine Department, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain. 14. Department of Anaesthesiology, Hospital Universitario Infanta Sofia, Madrid, Spain. 15. Department of Internal Medicine, Hospital Universitario Rio Hortega, Valladolid, Spain. 16. "San Rafael" Centre for Health Science, Universidad Antonio de Nebrija, Madrid, Spain. 17. Spanish National Hip Fracture Registry, Madrid, Spain. 18. Department of Preventive Medicine, Public Health and Microbiology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
Abstract
This study was carried out to analyze the evolution of the quality indicators in the Spanish National Hip Fracture Registry, after disseminating a series of recommendations based on available clinical practice guidelines to the participating hospitals. Six of the seven proposed quality indicators showed a significant improvement. PURPOSE: The Spanish National Hip Fracture Registry (RNFC) arises from the need to know the process and improve the quality of care. Our goal was to analyze the changes in the RNFC's quality indicators after an intervention based on disseminating specific recommendations among the participating hospitals, following available clinical practice guidelines. METHODS: Study comparing before and after performing an intervention in hospitals participating in the RNFC. Data from the hospitals that registered cases in 2017, and that kept registering cases in 2019. Seven quality indicators were chosen, and a standard to be achieved for each indicator was proposed. The intervention consisted in the dissemination of 25 recommendations with practical measures to improve each quality indicator, based on available clinical practice guidelines, by drafting and publishing a scientific paper and sending it via email and printed cards. Fulfilment of each quality indicator was measured after carrying out the intervention. RESULTS: Forty-three hospitals registered 2674 cases between January and May, 2017, and 8037 during 2019. The quality indicators chosen and the degree of compliance were (all with p<0.05): (1) surgery ≤48 h increased from 38.9 to 45.8%; (2) patients mobilised on the first postoperative day increased from 58.9 to 70.3%; (3) patients with anti-osteoporotic medication at discharge increased from 34.5 to 49.8%; (4) patients with calcium supplements at discharge increased from 48.7 to 62.8%; (5) patients with vitamin D supplements at discharge increased from 71.5 to 84.7%; (6) patients developing a grade >2 pressure ulcer during admission decreased from 6.5 to 5.0%; (7) patients able to move on their own at 1 month fell from 58.8 to 56.4%. More than 48% of hospitals improved the proposed indicators. CONCLUSION: Establishing quality indicators and standards and intervening through the dissemination of specific recommendations to improve these indicators achieved an improvement in hospital performance results on a national level.
This study was carried out to analyze the evolution of the quality indicators in the Spanish National Hip Fracture Registry, after disseminating a series of recommendations based on available clinical practice guidelines to the participating hospitals. Six of the seven proposed quality indicators showed a significant improvement. PURPOSE: The Spanish National Hip Fracture Registry (RNFC) arises from the need to know the process and improve the quality of care. Our goal was to analyze the changes in the RNFC's quality indicators after an intervention based on disseminating specific recommendations among the participating hospitals, following available clinical practice guidelines. METHODS: Study comparing before and after performing an intervention in hospitals participating in the RNFC. Data from the hospitals that registered cases in 2017, and that kept registering cases in 2019. Seven quality indicators were chosen, and a standard to be achieved for each indicator was proposed. The intervention consisted in the dissemination of 25 recommendations with practical measures to improve each quality indicator, based on available clinical practice guidelines, by drafting and publishing a scientific paper and sending it via email and printed cards. Fulfilment of each quality indicator was measured after carrying out the intervention. RESULTS: Forty-three hospitals registered 2674 cases between January and May, 2017, and 8037 during 2019. The quality indicators chosen and the degree of compliance were (all with p<0.05): (1) surgery ≤48 h increased from 38.9 to 45.8%; (2) patients mobilised on the first postoperative day increased from 58.9 to 70.3%; (3) patients with anti-osteoporotic medication at discharge increased from 34.5 to 49.8%; (4) patients with calcium supplements at discharge increased from 48.7 to 62.8%; (5) patients with vitamin D supplements at discharge increased from 71.5 to 84.7%; (6) patients developing a grade >2 pressure ulcer during admission decreased from 6.5 to 5.0%; (7) patients able to move on their own at 1 month fell from 58.8 to 56.4%. More than 48% of hospitals improved the proposed indicators. CONCLUSION: Establishing quality indicators and standards and intervening through the dissemination of specific recommendations to improve these indicators achieved an improvement in hospital performance results on a national level.
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