Hip fracture quality indicators: A scoping review
This study highlights the need for the development of important and feasible quality of care indicators for hip fracture patients within the post-acute care period.
Research Results
Findings: Titles and abstracts of 2,053 articles were screened. The full text of 495 articles was then screened for inclusion, of which only 201 were deemed relevant for data extraction. Only 19 studies were Canadian, with most studies from the United Kingdom (n=46) or the United States (n=37). Most quality of care indicators were developed and used to evaluate delivery within acute care (i.e. time to surgery), including rehabilitation within acute care (i.e. number of rehabilitation hours). Although measures of functional improvement (i.e. Activities of Daily Living) or balance (i.e. Berg balance scale) were used to evaluate patients’ progress within post-acute care settings (i.e. home-based rehabilitation), there were few quality of care indicators used. In an effort to improve quality of care for patients and create a more efficient healthcare system, mechanisms for the measurement of quality of care should be in place in both acute and post-acute settings.
Impact of findings: The implementation of quality of care indicators enables stakeholders to target areas for improvement in service delivery across the continuum. As hip fracture patients have significant morbidity that must be addressed in the post-acute care period, the inability to appropriately measure quality of care delivery during this period is concerning. Future work should focus on development of performance measures within the post-acute period.
About the Project
Hip fracture quality of care indicators were defined as a performance measure with a descriptive statement used in either the acute or post-acute care period. Literature search strategies were developed using medical subject headings and text words related to hip fracture quality indicators and were peer-reviewed.
This literature review on quality of care indicators for hip fracture patients revealed that although there are a number of previously used quality indicators for hip fracture patients residing in acute care, there are few quality indicators implemented within the acute care period. This finding is concerning as hip fracture patients, due to the need for rehabilitation after surgery, require relatively more post-acute compared to acute care services.
The implementation of quality of care indicators enables stakeholders to target areas for improvement in service delivery across the continuum. As hip fracture patients have significant morbidity that must be addressed in the post-acute care period, the inability to appropriately measure quality of care delivery during this period is concerning. Future work should focus on development of performance measures within the post-acute period.
Project Team
Principal Investigator:
Susan Jaglal, PhD, MSc, BSc — University of Toronto
Co-Investigators:
Lauren Beaupre, PhD — University of Alberta
Suzanne Morin, MD, MSc, FRCP, FACP — McGill University
Sarah Munce, PhD — Toronto Rehabilitation Institute
Laure Perrier, MLIS, MEd — University of Toronto
Knowledge Users and Partners:
Rhona McGlasson, MBA — Bone and Joint Canada
Project Contact: Dr. Susan Jaglal — susan.jaglal@utoronto.ca
Publications
Pitzul, K.B., Munce, S.E.P., Perrier, L., Beaupre, L., Morin, S.N., McGlasson, R., Jaglal, S.B. (September 2014). Quality indicators for hip fracture patients: A scoping review protocol. BMJ Open. In Press
Presentations
Pitzul, K.B., Munce, S.E.P., Perrier, L., Beaupre, L., Morin, S.N., McGlasson, R., Jaglal, S.B. (November 20, 2014). Quality indicators for hip fracture patients: A scoping review. Health Quality Ontario’s Health Quality Transformation Forum. Toronto, ON.
Webinars
Hip fracture quality indicators: a scoping review — Susan Jaglal and Kristen Pitzul
Rationale: Over 30,000 hip fractures occur annually in Canada and hip fractures are the second leading cause of hospitalization for Canadian seniors. The number of hip fractures are expected to increase by 2031, when approximately 25% of Canadians will be 65 years or older. Loss of function, autonomy and high mortality rates are common after a hip fracture. Care for these patients must therefore be optimized; however, there currently is no mechanism for measuring quality of care delivery for these patients in Canada.
Objectives: The purpose of this study was to synthesize the evidence surrounding quality of care indicators for patients who have sustained a hip fracture.
Research Plan: The synthesis was limited to quality of care indicators for individuals who suffered a hip fracture as a result of low trauma. Hip fracture quality of care indicators were defined as a performance measure with a descriptive statement used in either the acute or post-acute care period. All English peer-reviewed studies published from the year 2000-January 2014 were included. Literature search strategies were developed using medical subject headings and text words related to hip fracture quality indicators and were peer reviewed. Two reviewers independently screened the titles and abstracts identified by the literature search for inclusion using a piloted screening form. Full text of potentially relevant articles were then obtained and screened to determine final inclusion.
Lay Title: How good is the medical care for people who have had a hip fracture? How do we measure this?
Key Findings:
- We found that there are not enough ways to measure how good the medical care is for people with a hip fracture.
- After having a hip fracture, medical doctors can look at how the person walks or how happy they are but that is all. We need more ways to measure how good the medical care is for patients after suffering from a hip fracture surgery.
Why was this study was needed?
Researchers do not know how to measure how good the medical care is for people who have had a hip fracture. Without this, hospital staff cannot be confident that they are giving the best care for the person who has a hip fracture. We looked at all the research in this area to find out how healthcare providers measure the medical care received by people with a hip fracture.
Suggestions on how these findings could impact frail older adults and/or their family caregivers and how this might be measured:
- These findings impact older adults living with frailty. This study tells us that researchers need to create more ways to measure how good the medical care is for people who have had a hip fracture.
- Once researchers find a good measuring tool for this, the care given to the elderly with hip fracture will improve.
Brief comment on type of study in lay terms:
- The aim of the study was to see whether there is a way to measure how good the medical care is for people with hip fracture.
- This study summarized all the published research between 2000 and 2016 that mentioned different ways to measure the medical care for people with a hip fracture.
- Out of 2729 articles, we selected 302 articles to summarize based on various criteria.
- Our results tell us that we do not have ways to measure how good the medical care is for people with a hip fracture.
- After a hip fracture, medical doctors can look to see how the person walks or how happy they are – but that is all. We need more ways to measure how good the medical care is for patients after suffering from a hip fracture.
Lay Title: How good is the medical care for people who have had a hip fracture? How do we measure this?
Key Findings:
- To improve quality of care for patients with hip fracture and create a more efficient healthcare system, we require mechanisms for the measurement of quality of care across the entire continuum of care.
- Our study highlights the lack of indicators or potential indicators implemented within the post-acute care period for patients with hip fracture in the literature.
- Two important potential indicators for quality of rehabilitative care in the post-acute period that were found in the literature were functional ability and quality of life.
Why was this study was needed?
Although some studies have used process and outcome measures to evaluate care delivered in the post-acute period (e.g., a home-based rehabilitation program), there is a lack of identified, evidence-based quality of care indicators in the post-acute care period for patients with hip fracture. Without measures of quality of care in the post-acute period for patients with hip fracture, frontline staff, administrators and policymakers are left without required information to assess the delivery of care during the postsurgical rehabilitation period.
Suggestions on how administrators or policy maker could use the findings:
- To improve quality of care for patients and create a more efficient healthcare system, mechanisms for the measurement of quality of care are required.
- The implementation of quality of care indicators enables stakeholders to target areas for improvement in service delivery. Owing to the requirement for rehabilitation after surgery for patients with hip fracture, the inability to measure quality of care in the post-acute period is concerning.
Brief comment on type of study in lay terms:
- We aimed to gather the evidence from published literature on existing or potential quality of care indicators in the acute or post-acute period or across the continuum of care for older adults with hip fracture.
- We reviewed all English language peer-reviewed studies published from January 2000 to January 2016.
- Our search yielded 2729 unique articles, of which 302 (11%) articles were included.
Lay Title: A review of the potential quality indicators for hip fracture patient care
Key Findings:
- To improve quality of care for patients with hip fracture and create a more efficient healthcare system, we require measurements of quality of care across the entire continuum, not just during the acute period.
- Our literature search highlights a lack of indicators or potential indicators implemented within the post-acute care period for patients with hip fracture.
- Based on the literature, two important potential indicators for quality of rehabilitative care in the post-acute period are functional ability and quality of life.
Why was this study needed?
Although some studies have used process and outcome measures to evaluate care delivered in the post-acute period (e.g., a home-based rehabilitation program), there is a lack of identified, evidence-based quality of care indicators in the post-acute care period for patients with hip fracture. Without measures of quality of care in the post-acute period for patients with hip fracture, the frontline staff, administrators and policymakers are left without required information to assess the delivery of care during the postsurgical rehabilitation period.
Brief overview of the methodology:
- We aimed to synthesize the evidence on existing or potential quality of care indicators in the acute or post-acute period or across the continuum of care for older adults with hip fracture.
- A scoping review methodology was employed. English language peer-reviewed studies published from January 2000 to January 2016 were included.
- Measures targeted at patients, institutions or health systems were included and encompassed care processes and outcomes in the acute and post-acute period.
- The search yielded 2729 unique articles, of which 302 articles were included (11%).
- When indicators (e.g., in-hospital mortality) and potential indicators (e.g., comorbidities developed in hospital) were grouped by the outcome or process construct they were trying to measure, the most common constructs were measures of mortality (outcome), length of stay (process) and time-sensitive measures.
Potential impact of findings on clinical practice/patient care and how this impact might be measured:
- To improve quality of care for patients and create a more efficient healthcare system, mechanisms for the measurement of quality of care are required.
- The implementation of quality of care indicators enables stakeholders to target areas for improvement in service delivery. Owing to the requirement for rehabilitation after surgery for patients with hip fracture, the inability to measure quality of care in the post-acute period is concerning.
Remaining knowledge/research gaps:
- Future research should focus on decreasing the heterogeneity in definitions of quality indicators and the development and implementation of quality indicators for the post-acute period.
CFN Webinar (August 19, 2015): Hip fracture quality indicators: a scoping review