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Recommended care received by geriatric hip fracture patients: where are we now and where are we heading?

  • Trauma Surgery
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Abstract

Introduction

Despite the availability of clinical guidelines on the prevention and treatment of geriatric hip fractures, the percentage of recommended care received by patients is low. We conducted an importance–performance analysis for prioritizing interventions to improve the in-hospital management of these patients.

Materials and methods

A secondary data analysis was conducted on the in-hospital treatment of 540 geriatric hip fracture patients in 34 hospitals in Belgium, Italy, and Portugal. First, we assessed the level of expert consensus on the process indicators composing international guidelines on hip fracture treatment. Second, guideline adherence on in-hospital care was evaluated within and across hospitals. Third, an importance–performance analysis was conducted, linking expert consensus to guideline adherence.

Results

Level of expert consensus was high (above 75%) for 12 of 22 process indicators identified from the literature. There is large between and within hospital variation in guideline adherence for these indicators and for none of the 540 patients were all 22 process indicators adhered to. Importance–performance analysis demonstrated that three indicators that had a high level of expert consensus also had a high level of adherence (above 80%). Nine indicators, most of which have been previously linked to patient outcomes, had a high level of expert consensus but a consistently low level of adherence across hospitals and are identified as priority areas for improvement.

Conclusions

Guideline adherence for the treatment of geriatric hip fracture patients is remarkably suboptimal. Importance–performance analysis is a useful strategic approach to assist practitioners and healthcare managers to improve the quality of care.

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Acknowledgements

We thank all the professionals in the participating hospitals who were involved in the data collection.

Funding

The study was funded by Pfizer SA (unrestricted education grant). The funders had no role in the design, data collection, analysis, interpretation of data, writing of the report, or decision to submit the report for publication. KV received grants from Baxter and Astra Zeneca.

Author information

Authors and Affiliations

  1. Department of Public Health and Primary Care, KU Leuven-University of Leuven, Kapucijnenvoer 35/7001, 3000, Leuven, Belgium

    Deborah Seys, Walter Sermeus, Massimiliano Panella, Luk Bruyneel & Kris Vanhaecht

  2. Department of Development and Regeneration, KU Leuven-University of Leuven, Herestraat 49, 3000, Leuven, Belgium

    An Sermon

  3. Department of Traumatology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    An Sermon

  4. Department of Translational Medicine, University of Eastern Piedmont “A. Avogadro”, Via Solaroli 17, 28100, Novara Piedmont, Italy

    Massimiliano Panella

  5. Department of Quality Management, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Luk Bruyneel & Kris Vanhaecht

  6. Department of Health Services Policy and Management Centro de Investigação em Saúde Pública (CISP), Escola Nacional de Saúde Pública (ENSP), Universidade Nova de Lisboa (UNL), Av. Padre Cruz, 1600-560, Lisbon, Portugal

    Paulo Boto

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  1. Deborah Seys
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Correspondence to Kris Vanhaecht.

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Conflict of interest

Deborah Seys, An Sermon, Walter Sermeus, Massimiliano Panella, Luk Bruyneel, Paulo Boto, and Kris Vanhaecht declare that they have no conflict of interest.

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An Sermon: Joint first author.

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Seys, D., Sermon, A., Sermeus, W. et al. Recommended care received by geriatric hip fracture patients: where are we now and where are we heading?. Arch Orthop Trauma Surg 138, 1077–1087 (2018). https://doi.org/10.1007/s00402-018-2939-4

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  • DOI: https://doi.org/10.1007/s00402-018-2939-4

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