1
|
Harris E, Clement N, MacLullich A, Farrow L. The impact of an ageing population on future increases in hip fracture burden. Bone Joint J 2024; 106-B:62-68. [PMID: 38160690 DOI: 10.1302/0301-620x.106b1.bjj-2023-0740.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Aims Current levels of hip fracture morbidity contribute greatly to the overall burden on health and social care services. Given the anticipated ageing of the population over the coming decade, there is potential for this burden to increase further, although the exact scale of impact has not been identified in contemporary literature. We therefore set out to predict the future incidence of hip fracture and help inform appropriate service provision to maintain an adequate standard of care. Methods Historical data from the Scottish Hip Fracture Audit (2017 to 2021) were used to identify monthly incidence rates. Established time series forecasting techniques (Exponential Smoothing and Autoregressive Integrated Moving Average) were then used to predict the annual number of hip fractures from 2022 to 2029, including adjustment for predicted changes in national population demographics. Predicted differences in service-level outcomes (length of stay and discharge destination) were analyzed, including the associated financial cost of any changes. Results Between 2017 and 2021, the number of annual hip fractures increased from 6,675 to 7,797 (15%), with a rise in incidence from 313 to 350 per 100,000 (11%) for the at-risk population. By 2029, a combined average projection forecast the annual number of hip fractures at 10,311, with an incidence rate of 463 per 100,000, representing a 32% increase from 2021. Based upon these projections, assuming discharge rates remain constant, the total overall length of hospital stay following hip fracture in Scotland will increase by 60,699 days per annum, incurring an additional cost of at least £25 million per year. Approximately five more acute hip fracture beds may be required per hospital to accommodate this increased activity. Conclusion Projection modelling demonstrates that hip fracture burden and incidence will increase substantially by 2029, driven by an ageing population, with substantial implications for health and social care services.
Collapse
Affiliation(s)
- Euan Harris
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Nick Clement
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Alasdair MacLullich
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Luke Farrow
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
- Grampian Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, UK
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
2
|
Farrow L, Clement ND, Mitchell L, Sattar M, MacLullich AMJ. Does the time to surgery influence outcomes for patients with a hip fracture who undergo total hip arthroplasty? Bone Joint J 2023; 105-B:1201-1205. [PMID: 37907072 DOI: 10.1302/0301-620x.105b11.bjj-2023-0597.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Aims Surgery is often delayed in patients who sustain a hip fracture and are treated with a total hip arthroplasty (THA), in order to await appropriate surgical expertise. There are established links between delay and poorer outcomes in all patients with a hip fracture, but there is little information about the impact of delay in the less frail patients who undergo THA. The aim of this study was to investigate the influence of delayed surgery on outcomes in these patients. Methods A retrospective cohort study was undertaken using data from the Scottish Hip Fracture Audit between May 2016 and December 2020. Only patients undergoing THA were included, with categorization according to surgical treatment within 36 hours of admission (≤ 36 hours = 'acute group' vs > 36 hours = 'delayed' group). Those with delays due to being "medically unfit" were excluded. The primary outcome measure was 30-day survival. Costs were estimated in relation to the differences in the lengths of stay. Results A total of 1,375 patients underwent THA, with 397 (28.9%) having surgery delayed by > 36 hours. There were no significant differences in the age, sex, residence prior to admission, and Scottish Index of Multiple Deprivation for those with, and those without, delayed surgery. Both groups had statistically similar 30-day (99.7% vs 99.3%; p = 0.526) and 60-day (99.2% vs 99.0%; p = 0.876) survival. There was, however, a significantly longer length of stay for the delayed group (acute: 7.0 vs delayed: 8.9 days; p < 0.001; overall: 8.7 vs 10.2 days; p = 0.002). Delayed surgery did not significantly affect the rates of 30-day readmission (p = 0.085) or discharge destination (p = 0.884). The results were similar following adjustment for potential confounding factors. The estimated additional cost due to delayed surgery was £1,178 per patient. Conclusion Delayed surgery does not appear to be associated with increased mortality in patients with an intracapsular hip fracture who undergo THA, compared with those who are treated with a hemiarthroplasty or internal fixation. Those with delayed surgery, however, have a longer length of stay, with financial consequences. Clinicians must balance ethical considerations, the local provision of orthopaedic services, and optimization of outcomes when determining the need to delay surgery in a patient with a hip fracture awaiting THA.
Collapse
Affiliation(s)
- Luke Farrow
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Grampian Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, UK
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
| | - Nick D Clement
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Lewis Mitchell
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Mariam Sattar
- Grampian Orthopaedics, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Alasdair M J MacLullich
- Scottish Hip Fracture Audit, Public Health Scotland, Edinburgh, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
3
|
Tritany ÉF, Franco TB, Mendonça PEXD. Panorama da produção científica sobre Cuidados Intermediários e Hospitais Comunitários: uma revisão integrativa. SAÚDE EM DEBATE 2021. [DOI: 10.1590/0103-1104202112918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Mudanças epidemiológicas decorrentes do envelhecimento populacional motivaram transformações nos sistemas de saúde mundiais. Desde 1990, emergem discussões sobre Cuidados Intermediários (CI), visando diminuir hospitalizações, melhorar a coordenação do cuidado e estimular políticas públicas de cuidados próximos ao território. Este trabalho objetivou apresentar e analisar a literatura científica sobre CI, enfatizando serviços de Hospitais Comunitários. Realizou-se uma revisão integrativa, combinando os descritores “Intermediate Care”, “Community Hospitals”, “Intermediate Care Facilities”, “Long-Term Care”, “Hospitals Chronic Disease” e “Rehabilitation Services”, nos idiomas português, inglês e espanhol, nas bases Portal Regional da Biblioteca Virtual em Saúde, PubMed e Biblioteca Digital Brasileira de Teses e Dissertações. Após processo de busca e elegibilidade, foram incluídos 30 documentos para síntese qualitativa, provenientes de: Reino Unido, Noruega, Espanha, Dinamarca, Austrália e Itália. Resultados apontam para a eficácia, a efetividade e a eficiência dos CI, com boas avaliações por parte de profissionais e usuários. Os CI, como estratégia de fortalecimento da Atenção Primária à Saúde, redução de internações, favorecimento da independência funcional dos pacientes e seu retorno à comunidade, apresentam-se como uma inovação em saúde e aposta promissora. Entretanto, persistem lacunas na literatura que ensejam mais estudos sobre o tema, com vistas a subsidiar a tomada de decisão.
Collapse
|
4
|
Young J, Hulme C, Smith A, Buckell J, Godfrey M, Holditch C, Grantham J, Tucker H, Enderby P, Gladman J, Teale E, Thiebaud JC. Measuring and optimising the efficiency of community hospital inpatient care for older people: the MoCHA mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background
Community hospitals are small hospitals providing local inpatient and outpatient services. National surveys report that inpatient rehabilitation for older people is a core function but there are large differences in key performance measures. We have investigated these variations in community hospital ward performance.
Objectives
(1) To measure the relative performance of community hospital wards (studies 1 and 2); (2) to identify characteristics of community hospital wards that optimise performance (studies 1 and 3); (3) to develop a web-based interactive toolkit that supports operational changes to optimise ward performance (study 4); (4) to investigate the impact of community hospital wards on secondary care use (study 5); and (5) to investigate associations between short-term community (intermediate care) services and secondary care utilisation (study 5).
Methods
Study 1 – we used national data to conduct econometric estimations using stochastic frontier analysis in which a cost function was modelled using significant predictors of community hospital ward costs. Study 2 – a national postal survey was developed to collect data from a larger sample of community hospitals. Study 3 – three ethnographic case studies were performed to provide insight into less tangible aspects of community hospital ward care. Study 4 – a web-based interactive toolkit was developed by integrating the econometrics (study 1) and case study (study 3) findings. Study 5 – regression analyses were conducted using data from the Atlas of Variation Map 61 (rate of emergency admissions to hospital for people aged ≥ 75 years with a length of stay of < 24 hours) and the National Audit of Intermediate Care.
Results
Community hospital ward efficiency is comparable with the NHS acute hospital sector (mean cost efficiency 0.83, range 0.72–0.92). The rank order of community hospital ward efficiencies was distinguished to facilitate learning across the sector. On average, if all community hospital wards were operating in line with the highest cost efficiency, savings of 17% (or £47M per year) could be achieved (price year 2013/14) for our sample of 101 wards. Significant economies of scale were found: a 1% rise in output was associated with an average 0.85% increase in costs. We were unable to obtain a larger community hospital sample because of the low response rate to our national survey. The case studies identified how rehabilitation was delivered through collaborative, interdisciplinary working; interprofessional communication; and meaningful patient and family engagement. We also developed insight into patients’ recovery trajectories and care transitions. The web-based interactive toolkit was established [http://mocha.nhsbenchmarking.nhs.uk/ (accessed 9 September 2019)]. The crisis response team type of intermediate care, but not community hospitals, had a statistically significant negative association with emergency admissions.
Limitations
The econometric analyses were based on cross-sectional data and were also limited by missing data. The low response rate to our national survey means that we cannot extrapolate reliably from our community hospital sample.
Conclusions
The results suggest that significant community hospital ward savings may be realised by improving modifiable performance factors that might be augmented further by economies of scale.
Future work
How less efficient hospitals might reduce costs and sustain quality requires further research.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 1. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- John Young
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK
| | - Claire Hulme
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Andrew Smith
- Institute for Transport Studies, University of Leeds, Leeds, UK
| | - John Buckell
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Mary Godfrey
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK
| | | | | | - Helen Tucker
- Community Hospitals Association, Crowborough, UK
| | - Pam Enderby
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - John Gladman
- University of Nottingham Medical School, University of Nottingham, Nottingham, UK
| | - Elizabeth Teale
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK
| | | |
Collapse
|