Hip fracture

Hip fracture is a leading cause of death and disability among the elderly worldwide. The incidence is rising as populations age, and there are now over 1.6 million hip fractures globally each year. In the United Kingdom alone, there are 70 000 cases annually at a cost of £2 billion.

However, hip fractures are a major cause of death and disability among older people worldwide; with 70,000 cases every year in the UK, which cost the NHS around £2 billion. In 2010, a Best Practice Tariff (BPT) is launched across England; which promised extra payments to hospitals for each hip fracture patient whose care satisfied six clinical standards; such as surgery within 36 hours.

Researchers from the University of Oxford and Yale University compared the data from England with that in Scotland; which does not provide BPT payments to hospitals. But they found that the BPT scheme saved up to 7,600 lives in England between 2010 and 2016.

Elderly patients with a hip fracture

However, the principal aim of the study was to determine the effect of introducing a pay-for-performance initiative on outcomes for elderly patients with a hip fracture. However, the Hip Fracture BPT was only feasible once a framework had established for capturing high-quality clinical audit data. But this study was a natural experiment using interrupted time series and difference-in-differences (DID) analysis.

It relied on national data from two sources in order to conduct quasi-experimental modelling of temporal trends. Changes in England, where the NHFD/BPT introduced, analyzed as an ‘exposed’ group and those in Scotland as a ‘control’. Given the countries’ geographical proximity, cultural similarities, and common political union within the United Kingdom, it is anticipated that secular changes in Scotland would closely mimic those in England the NHFD/BPT not implement.

Reduced the number of patients

David Metcalfe of Oxford’s Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, said: ‘This is the first study to show that the Best Practice Tariff drove changes in practice that reduced mortality for older adults with a hip fracture in England. ‘The research also suggests that the BPT led to generally improved standards of care for hip fracture patients.

It increased the proportion of patients receiving an operation within 36 hours; shortened the average length of stay in hospital and reduced the number of patients that had to re-admit to hospital. ‘As it is possible that similar schemes could improve outcomes for patients and reduce costs for the NHS; they should support the controlled expansion of the BPT model to other clinical areas.’

A total of 1,037,860 adults aged over 60 admitted to hospitals between 2000; and 2016 with a hip fracture in England, and 116,594 in Scotland. Before the BPT scheme introduced; trends in 30-day mortality the same in England and Scotland. However, the number of hip fracture deaths fell much more markedly in England after the BPT introduced. A pre-existing trend towards increased numbers of patients requiring re-admission to hospital halted after the introduction of the BPT scheme.