Implementing a hip fracture registry and financial incentive program to enhance best practice in hip fracture care in Western Australia
Hannah Seymour A D , Diana Fajardo Pulido
B , Amanda Ling C and Rebecca Mitchell B
A Fiona Stanley Hospital, 1 Robin Warren Drive, Murdoch, WA 6150, Australia. Email: hannah.seymour@health.wa.gov.au
B Australian Institute of Health Innovation, Macquarie University, Sydney, NSW 2109, Australia. Email: diana.fajardopulido@mq.edu.au; r.mitchell@mq.edu.au
C Ramsay Health Care, Joondalup Health Campus, Joondalup, WA 6027, Australia. Email: linga@ramsayhealth.com.au
D Corresponding author. Email: hannah.seymour@health.wa.gov.au
Australian Health Review 45(2) 143-147 https://doi.org/10.1071/AH20032
Submitted: 14 February 2020 Accepted: 25 May 2020 Published: 19 March 2021
Abstract
Hip fracture is a common injury in older adults that causes significant morbidity and mortality. Older adults who sustain a hip fracture are at a higher risk of institutionalisation, reduced mobility and subsequent falls and, consequently, have increased rates of morbidity and mortality. Quality improvement strategies that address gaps in hip fracture care are needed to ensure best practice and improve health outcomes for older adults.
This case study describes the development of a state-based hip fracture registry and incentive payment scheme in Western Australia (WA), which were designed to drive quality improvement. The registry monitored best practice in hip fracture care criteria across three tertiary hospitals in WA, and the incentive program provided premium payments to these hospitals for meeting six criteria in best practice clinical quality. The fracture registry commenced in 2011, and by 2014 all participating hospitals were eligible for payments. From 2014 to 2016, the proportion of patients who were operated on within 36 hours increased from 60% to 79%. This case study illustrates how a hip fracture registry in conjunction with small premium payments improved well-described process measures in hip fracture care.
What is known about the topic? Hip fracture is a common among older adults, usually resulting from a fall. International clinical quality registries have been shown to help drive quality improvements in patient care processes and outcomes.
What does this paper add? This paper adds an Australian perspective to the existing literature on the efficacy of hip fracture clinical quality registries. It offers an example of how a Western Australian hip fracture registry with an associated incentive payment program drove clinical care and process change to improve care provision and patient outcomes.
What are the implications for practitioners? This case study suggests regular monitoring and reporting on hip fracture care processes and patient outcomes can lead to improvements in both of these measures. Because incentive payments may have contributed to the best practice improvements noted in this case study, practitioners involved in designing future monitoring and reporting programs should consider the merits of incorporating financial incentives.
Keywords: best practice, care coordination, financial incentives, fracture care, fracture registry, geriatric care, hip fracture, incentive payment scheme, morbidity, mortality, older adults, orthogeriatric care, process improvement, quality care, tertiary hospital.
References
[1] Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc 2003; 51 364–70.| Estimating hip fracture morbidity, mortality and costs.Crossref | GoogleScholarGoogle Scholar | 12588580PubMed |
[2] Australian Institute of Health and Welfare (AIHW). Hip fracture incidence and hospitalisations in Australia 2015–16. Cat. no. PHE 226. Canberra: AIHW; 2018.
[3] Loefler A, Close J. Rising costs of hip fractures. Med J Aust 2016; 205 64–5.
| Rising costs of hip fractures.Crossref | GoogleScholarGoogle Scholar | 27456446PubMed |
[4] Bentler SE, Liu L, Obrizan M, Cook EA, Wright KB, Geweke JF, Chrischilles EA, Pavlik CE, Wallace RB, Ohsfeldt RL, Jones MP, Rosenthal GE, Wolinsky FD. The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol 2009; 170 1290–9.
| The aftermath of hip fracture: discharge placement, functional status change, and mortality.Crossref | GoogleScholarGoogle Scholar | 19808632PubMed |
[5] Dyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, Sherrington C, for the Fragility Fracture Network (FFN) Rehabilitation Research Special Interest Group A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 2016; 16 158
| A critical review of the long-term disability outcomes following hip fracture.Crossref | GoogleScholarGoogle Scholar | 27590604PubMed |
[6] Lystad R, Cameron C, Mitchell R. Mortality risk among older Australians hospitalised with hip fracture: a population-based matched cohort study. Arch Osteoporos 2017; 12 67
| Mortality risk among older Australians hospitalised with hip fracture: a population-based matched cohort study.Crossref | GoogleScholarGoogle Scholar | 28726112PubMed |
[7] Australian and New Zealand Hip Fracture Registry (ANZHFR). ANZHFR 2018 annual report. Randwick: ANZHFR; 2018. Available at: https://anzhfr.org/2018-national-report/ [verified 16 November 2020].
[8] Kim S-M, Moon Y-W, Lim S-J, Yoon B-K, Min Y-K, Lee D-Y, Park Y-S. Prediction of survival, second fracture, and functional recovery following the first hip fracture surgery in elderly patients. Bone 2012; 50 1343–50.
| Prediction of survival, second fracture, and functional recovery following the first hip fracture surgery in elderly patients.Crossref | GoogleScholarGoogle Scholar | 22421579PubMed |
[9] Mak JC, Cameron ID, MArch LM. Evidence-based guidelines for the management of hip fractures in older persons: an update. Med J Aust 2010; 192 37–41.
| Evidence-based guidelines for the management of hip fractures in older persons: an update.Crossref | GoogleScholarGoogle Scholar | 20047547PubMed |
[10] Royal College of Physicians (RCP). National Hip Fracture Database annual report. London: RCP; 2018. Available at: https://www.nhfd.co.uk/2018report [verified 16 November 2020].
[11] NHFD Implementation Group. The National Hip Fracture Database National Report 2011. 2011. Available at: https://www.nhfd.co.uk/20/hipfractureR.nsf/xsp/.ibmmodres/domino/OpenAttachment/20/hipfracturer.nsf/F8D3494186E154CB802579C900553968/Attachment/NHFDNationalReport2011.pdf [verified 16 November 2020].
[12] Knudsen SV, Laursen HVB, Johnsen SP, Bartels PD, Ehlers LH, Mainz J. Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects. BMC Health Serv Res 2019; 19 683
| Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects.Crossref | GoogleScholarGoogle Scholar | 31585540PubMed |
[13] ANZHFR. Australian and New Zealand guideline for hip fracture care: improving outcomes in hip fracture management of adults. 2014. Available at: https://anzhfr.org/wp-content/uploads/2016/07/ANZ-Guideline-for-Hip-Fracture-Care.pdf [verified 16 November 2020].
[14] Australian Commission on Safety and Quality in Health Care. Hip fracture care clinical care standard. 2016. Available at: https://www.safetyandquality.gov.au/our-work/clinical-care-standards/hip-fracture-care-clinical-care-standard [verified 16 November 2020].
[15] Doruk H, Mas MR, Yildiz C, Sonmez A, Kyrdemir V. The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly. Arch Gerontol Geriatr 2004; 39 179–85.
| The effect of the timing of hip fracture surgery on the activity of daily living and mortality in elderly.Crossref | GoogleScholarGoogle Scholar | 15249154PubMed |
