Older patients with hip fractures recover better if they receive treatment under the supervision of both a surgeon and a specialist in elderly care; are checked to avoid future falls; and are assessed for memory problems.
In the UK, the National Health Service (NHS) has set standards for hip fracture care which identify seven indicators that doctors and healthcare providers are recommended to provide to improve patient outcomes and quality of life.
“These performance indicators are part of the UK NHS Best Practice Tariff (BPT), where providers are reimbursed based on the care delivered in the period following injury,” said Matthew Costa, Professor of Orthopaedic Trauma Surgery at the University of Oxford’s Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS).
“But it’s not clear whether the tariff is associated directly with improved patient outcomes or really how much difference each aspect of care makes to a person’s recovery. Through the WHiTE study we could test the seven recommendations to see which had the greatest impact and whether some should be prioritised by hospitals,” said Prof Costa, Co-Theme Lead for the Oxford BRC’s Musculoskeletal Theme.
A broken hip is the most common type of injury in older people and can have a devastating impact on pain and mobility, with a long-term reduction in a patient’s quality of life.
The WHiTE study, set up in 2014, recruited patients with hip fractures from 20 NHS hospitals in England to report on health-related quality of life outcomes.
Judged to be the most important outcome following this type of injury, the NDORMS team could measure the effectiveness of clinical care provided against patients’ quality of life, and from there which elements of best care lead to the most improvement.
The study looked at more than 8,000 patients aged 60 years and older who had been operated on for a broken hip. Patients received follow-up at four months to report on their quality of life. The researchers reviewed the treatment patients received against the seven indicators. Around half of patients received all seven recommended aspects of care and they recovered best.
The analysis showed that each of the seven aspects of care contributed to recovery but three stood out as most effective. These were:
- Admission under the joint care of a consultant surgeon and a specialist in the care of older people
- Checks to avoid falls and assess bone health
- Checks for memory problems before and after surgery
“This study is also the first to show that tariff payments linked to the delivery of recommendations for best care lead to better quality of life for patients,” Prof Costa said.
“In an ideal situation patients would receive all seven recommended care treatments and make the best recovery. Where this is not possible we would recommend that hospitals prioritise these three aspects that we have shown to have the greatest impact in improving quality of life following a hip fracture.”
As well as the NIHR, the WHiTE study is supported by the UK Musculoskeletal Trauma Patient and Public Involvement Group. It is also being used to test new treatments for patients. Current clinical trials include studies looking at surgical devices, new treatments to reduce infection, treatments to reduce confusion after surgery and to speed patients’ recovery.