Kristensen PK, Falstie-Jensen AM, Madsen M, Johnsen SP. Patient-related healthcare disparities in the quality of acute hip fracture care: a 10-year nationwide population-based cohort study.
BMJ Open 2021;
11:e051424. [PMID:
35446782 PMCID:
PMC8718470 DOI:
10.1136/bmjopen-2021-051424]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES
To characterise and quantify possible patient-related disparities in hip fracture care including temporal changes.
DESIGN
Population-based cohort study.
SETTING
All Danish hospitals treating patients with hip fracture.
PARTICIPANTS
60 275 hip fracture patients from 2007 to 2016.
INTERVENTIONS
Quality of care was defined as fulfilment of eligible care process measures for the individual patient recommended by an expert panel. Using yearly logistic regression models, we predicted the individual patient's probability for receiving high-quality care, resulting in a distribution of adjusted probabilities based on age, sex, comorbidity, fracture type, education, family mean income, migration status, cohabitation status, employment status, nursing home residence and type of municipality. Based on the distribution, we identified best-off patients (ie, the 10% of patients with the highest probability) and worst-off patients (ie, the 10% of patients with the lowest probability). We evaluated disparities in quality of care by measuring the distance in fulfilment of outcomes between the best-off and worst-off patients.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcome was fulfilment of all-or-none, defined as receiving all relevant process measures. Secondary outcomes were fulfilment of the individual process measures including preoperative optimisation, early surgery, early mobilisation, assessment of pain, basic mobility, nutritional risk and need for antiosteoporotic medication, fall prevention and a postdischarge rehabilitation programme.
RESULTS
The proportion of patients receiving high-quality care varied over time for both best-off and worst-off patients. The absolute difference in percentage points between the best-off and worst-off patients for receiving all-or-none of the eligible process measures was 12 (95% CI 6 to 18) in 2007 and 23 (95% CI 19 to 28) in 2016. Disparities were consistent for a range of care processes, including assessment of pain, mobilisation within 24 hours, assessment of need for antiosteoporotic medication and nutritional risk assessment.
CONCLUSIONS
Disparity of care between best-off and worst-off patients remained substantial over time.
Collapse