Towards a ANZ Hip Fracture Registry
“Quality Care Costs Less”
Hip fractures due to falls
Males and females, Australia 1999-2007
Age-standardised rate
Males
Females
900
800
700
600
500
400
300
200
100
0
1999–00 2000–01 2001–02 2002–03 2003–04 2004–05 2005–06 2006–07
Year of separation
Source: Bradley C. 2011. Hospitalisations due to falls by older people, Australia 2006–07.
Injury research and statistics series no. 56. Cat. no. INJCAT 132.
Australian Institute of Health and Welfare, Canberra.
Fragility hip fracture rates by year, WA, 1999-2009
Average yearly change:
Indigenous, +6.9% (95%CI 2-12%) vs non-Indigenous, -3.6% (95%CI 3-4%)
Falls and fracture care and prevention
A road map for a systematic approach
Stepwise
implementation based on size
of impact
Hip
fracture
patients
Non-hip fragility
fracture patients
Individuals at high risk of 1st
fragility fracture or other
injurious falls
Older people
Objective 1: Improve outcomes and improve
efficiency of care after hip fractures
Objective 2: Respond to the first fracture,
prevent the second – through Fracture
Liaison Services in acute and primary care
Objective 3: Early intervention to restore
independence – through falls care pathway
linking acute and urgent care services to
secondary falls prevention
Objective 4: Prevent frailty, preserve bone
health, reduce accidents – through
preserving physical activity, healthy lifestyles
and reducing environmental hazards
1. DH Prevention Package for Older People
Falls and fracture care and prevention
A road map for a systematic approach
Stepwise
implementation based on size
of impact
Hip
fracture
patients
High volume, high cost
Evidence around model/s of care
Evidence of clinical variation in practice
Objective 1: Improve
Evidence of sub-optimal
care outcomes and improve
efficiency of care after hip fractures
Evidence that data can be used to drive change
Non-hip fragility
fracture patients
Individuals at high risk of 1st
fragility fracture or other
injurious falls
Older people
Objective 2: Respond to the first fracture,
prevent the second – through Fracture
Liaison Services in acute and primary care
Objective 3: Early intervention to restore
independence – through falls care pathway
linking acute and urgent care services to
secondary falls prevention
Objective 4: Prevent frailty, preserve bone
health, reduce accidents – through
preserving physical activity, healthy lifestyles
and reducing environmental hazards
1. DH Prevention Package for Older People
Inter-professional collaboration 2004-2007
Six Blue Book standards – monitored by NHFD
1.
2.
3.
4.
5.
6.
All patients with hip fracture should be admitted to an acute
orthopaedic ward within 4 hours of presentation
All patients with hip fracture if medically fit should have surgery within
48 hours of admission, during normal working hours
All patients with hip fracture should be assessed and cared for to
minimise risk of a pressure ulcer
All patients presenting with a fragility fracture should be managed on an
orthopaedic ward with routine access to orthogeriatric medical support
from admission
All fragility fracture patients should be assessed for need of
antiresorptive therapy to prevent future osteoporotic fractures
All fragility fracture patients should be offered multidisciplinary
assessment and intervention to prevent future falls
UK NHFD Reports: 2008-2011
2011 - ALL eligible
hospitals
registered
191/191
Individual
reports for 26
hospitals
Analysis on
12,983 records
from 64 hospitals
Analysis on 36,556
records from 129
hospitals
Analysis on 53,443 records
from 176 hospitals
2011 National Hip Fracture Database Report
Key metrics
Surgery within 36 hours
Pre-op medical assessment
Acute Length of Stay
NHFD 2011 National Report. Available from www.nhfd.co.uk
Three-year trend data:
30,022 patients from 28 hospitals
Binomial test p-value <0.001 for all trends;
average mortality at 30 days fell from 9.4% to 8%.
National Steering
Group
States and
Territories
LHDs
Hospitals
Resourcing
models of care
Local training /
support
Implementing
best practice
Measuring
performance
Registry
National
Guidelines
Quality Indicators
Consumer
Manifesto
Policy
Models of Care
Safety & Quality
System Redesign
Training /
Education
National Hip Fracture Database
• Employs 4 people and now funded by DOH
• Now has got 189 of 191 hospitals sending data
(England, Wales, Northern Ireland)
• Annual reporting since 2008
– 2008:
?
patients from 26 hospitals
– 2009: 12,983 patients from 64 hospitals
– 2010: 36,556 patients from 129 hospitals
– 2011: 56,000 patients from 176 hospitals
82% of predicted hip fractures
National Hip Fracture Database
• Total hip fracture records = 137,933
– Reports process indicators and case-mix
adjusted outcomes (e.g. 30 day mortality)
– All hospitals identified in reports
Best Practice Tariff
Best Practice Tariff
• Aims
– To reduce unexplained variation in quality
– To universalise best practice
• Key indicators
– Surgery within 36 hours
– Involvement of Geriatricians
• Balanced Scorecard for Hip Fractures
BPT - Payment
• All criteria must be met
• Tariff
– Reduced previous average payment by 10%
– If criteria met – get old payment + extra
– Extra = £445
• If doing 300 / yr = £134,000 = $270,000 per yr
• From 2011: £890 = £267,000 = $530,000 per yr
• Enough to allow investment in change, improvement
and data collection
How System Works
Notify BPT compliance
Commissioners
National Hip
Fracture
Database
Provide NHI
and
individual
patient data
Local Hospital
Importance of “trust” in each segment of system
Pay
additional
funds
quarterly
So why have a registry?
• Improve patient outcomes
– Death, dependency and institutionalisation
• Safety and quality
– e.g. timely and appropriate interventions
• Reduce inequalities
– Local organisational, rural remote
• Driver for organisational change
• Use the data to shape practice
• Undertake additional research
Australia and New Zealand Hip
Fracture Database
• Inaugural Meeting October 2011
• Working Group Established
• Strong support from HQSC – NZ & Aust
•
Professional Societies
•
OA NZ & Aust
Progress with a National Registry
•
•
•
•
Auditing at facility level – NSW, NZ, WA
Piloting at patient level in NSW
WA/CMDHB have started electronic database
Guidelines and quality indicators to be
completed in 2012
• Consumer manifesto – 2012
• Conversations re build and operation of a
national database
Progress
• NZ Workshop planned May 2012 led by HQSC,
NZ with NZ stakeholders participating
• (ACC, MOH, NHB, IT board, CNBU)
Discussion
• Thank you