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Karimi-Dehkordi M, Hanson HM, Kennedy M, Wagg A. Mapping Quality Indicators to Assess Older Adult Health and Care in Community-, Continuing-, and Acute-Care Settings: A Systematic Review of Reviews and Guidelines. Healthcare (Basel) 2024; 12:1397. [PMID: 39057540 DOI: 10.3390/healthcare12141397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/29/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Quality indicators (QIs) play a vital role in enhancing the care of older adults. This study aimed to identify existing QIs relevant to the health and care of older adults in community-care, continuing-care, and acute-care settings, along with available information such as definitions and calculation methods. A systematic review of published review studies, grey literature, and guidelines was undertaken, utilizing six electronic databases searched for materials dated from 2010 to 2 June 2023. To be included in this study, the literature had to provide data on QIs in a setting involving older adults. This study included 27 reviews and 44 grey literature sources, identifying a total of 6391 QIs. The highest number of indicators (37%) were relevant to continuing care; 32% and 28% were pertinent to community- and acute-care settings, respectively. The process domain had the highest number of QIs (3932), while the structure domain had the fewest indicators (521). A total of 39 focus areas were identified, with the five most common areas being, in descending order, orthopedics/hip fractures, end-of-life/palliative care, appropriate prescribing, neurocognitive conditions, and cardiovascular conditions; these areas ranged between 10% and 6%. When mapped against the Quadruple Aim framework, most QIs (85%) were linked to improving health outcomes. This inclusive compilation of QIs serves as a resource for addressing various focus areas pertinent to the Quadruple Aims. However, few quality indicators have been designed to provide a comprehensive and thorough evaluation of a specific aspect, taking into account all three key domains: structure, process, and outcomes. Addressing the description and psychometric properties of QIs is foundational for ensuring their trustworthiness and effective application.
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Affiliation(s)
- Mehri Karimi-Dehkordi
- Faculty of Medicine & Dentistry, Keyano College, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Heather M Hanson
- Provincial Seniors Health and Continuing Care, Alberta Health Services, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Megan Kennedy
- Geoffrey and Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Adrian Wagg
- Provincial Seniors Health and Continuing Care, Alberta Health Services, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada
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Ansari H, Fung K, Cheung AM, Jaglal S, Bogoch ER, Kurdyak PA. Outcomes following hip fracture surgery in adults with schizophrenia in Ontario, Canada: A 10-year population-based retrospective cohort study. Gen Hosp Psychiatry 2024; 89:60-68. [PMID: 38797059 DOI: 10.1016/j.genhosppsych.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/02/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To understand immediate and long-term outcomes following hip fracture surgery in adults with schizophrenia. METHODS Retrospective population-based cohort study leveraging health administrative databases from Ontario, Canada. Individuals aged 40-105 years with hip fracture surgery between April 1, 2009 and March 31, 2019 were included. Schizophrenia was ascertained using a validated algorithm. Outcomes were: 30-day mortality; 30-day readmission; 1-year survival; and subsequent hip fracture within 2 years. Analyses incorporated Generalized Estimating Equation models, Kaplan-Meier curves, and Fine-Gray competing risk models. RESULTS In this cohort study of 98,126 surgically managed hip fracture patients, the median [IQR] age was 83[75-89] years, 69.2% were women, and 3700(3.8%) had schizophrenia. In Fine-Gray models, schizophrenia was associated with subsequent hip fracture (sdRH, 1.29; 95% CI, 1.09-1.53), with male patients with schizophrenia sustaining a refracture 50 days earlier. In age- and sex-adjusted GEE models, schizophrenia was associated with 30-day mortality (OR, 1.31; 95% CI, 1.12-1.54) and readmissions (OR, 1.40; 95% CI, 1.25-1.56). Kaplan-Meier survival curves suggested that patients with schizophrenia were less likely to be alive at 1-year. CONCLUSIONS Study highlights the susceptibility of hip fracture patients with schizophrenia to worse outcomes, including refracture, with implications for understanding modifiable processes of care to optimize their recovery.
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Affiliation(s)
- Hina Ansari
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | | | - Angela M Cheung
- Department of Medicine and Joint Department of Medical Imaging, University Health Network and Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Susan Jaglal
- ICES, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Earl R Bogoch
- Brookfield Chair in Fracture Prevention, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Paul A Kurdyak
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Dos Santos VL, Sato KS, Maher CG, Vidal RVC, Grande GHD, Costa LOP, Machado GC, Ferreira GE, Buchbinder R, Oliveira CB. Clinical indicators to monitor health care in low back pain: a scoping review. Int J Qual Health Care 2024; 36:mzae044. [PMID: 38814664 DOI: 10.1093/intqhc/mzae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 05/27/2024] [Indexed: 05/31/2024] Open
Abstract
Clinical care indicators for low back pain can be used to monitor healthcare practices and consequently be used to evaluate success of strategies to improve care quality. The aim of this study was to identify the clinical care indicators that have been used to measure appropriateness of health care for patients with low back pain. We conducted a systematic search of five electronic databases and Google to identify clinical care indicators that have been used to measure any aspect of care for people with low back pain. Care indicators were narratively described according to their type (i.e. structure, process, or outcomes) and categorized by their purpose (e.g. to measure aspects related to assessment, imaging requests, treatment/prevention, and outcomes). A total of 3562 and 2180 records were retrieved from electronic databases and Google searches, respectively. We identified 280 indicators related to low back pain care from 40 documents and publications. Most quality indicators were process indicators (n = 213, 76%), followed by structure (n = 41, 15%) and outcome indicators (n = 26, 9%). The most common indicators were related to imaging requests (n = 41, 15%), referral to healthcare providers (n = 30, 11%), and shared decision-making (n = 21, 7%). Our review identified a range of clinical care indicators that have been used to measure the quality of health care for people with low back pain. Our findings will support a Delphi study to reach international consensus on what would be the most important and feasible indicators for a minimum dataset to be collected globally.
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Affiliation(s)
- Vanessa L Dos Santos
- Faculty of Medicine, University of Western São Paulo (UNOESTE), Presidente Prudente, Sao Paulo 19050-920, Brazil
| | - Karen S Sato
- Faculty of Medicine, University of Western São Paulo (UNOESTE), Presidente Prudente, Sao Paulo 19050-920, Brazil
| | - Chris G Maher
- Institute for Musculoskeletal Health, Sydney Local Health District, King George V Building, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, King George V Building, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia
| | - Rubens V C Vidal
- Faculty of Medicine, University of Western São Paulo (UNOESTE), Presidente Prudente, Sao Paulo 19050-920, Brazil
| | - Guilherme H D Grande
- Faculty of Medicine, University of Western São Paulo (UNOESTE), Presidente Prudente, Sao Paulo 19050-920, Brazil
- Departamento de Educação Física, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Rua Roberto Simonsen, 305, Presidente Prudente, Sao Pualo 19060-900, Brazil
| | - Leonardo O P Costa
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galeno, 448, Sao Paulo 03071-000, Brazil
| | - Gustavo C Machado
- Institute for Musculoskeletal Health, Sydney Local Health District, King George V Building, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, King George V Building, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia
| | - Giovanni E Ferreira
- Institute for Musculoskeletal Health, Sydney Local Health District, King George V Building, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, King George V Building, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia
| | - Rachelle Buchbinder
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, 4 Drysdale St, Malvern, Melbourne, Victoria 3144, Australia
| | - Crystian B Oliveira
- Faculty of Medicine, University of Western São Paulo (UNOESTE), Presidente Prudente, Sao Paulo 19050-920, Brazil
- Departamento de Educação Física, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, Rua Roberto Simonsen, 305, Presidente Prudente, Sao Pualo 19060-900, Brazil
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Giroux M, Sirois MJ, Gagnon MA, Émond M, Bérubé M, Morin M, Moore L. Identifying Quality Indicators for the Care of Hospitalized Injured Older Adults: A Scoping Review of the Literature. J Am Med Dir Assoc 2023; 24:929-936. [PMID: 37094747 DOI: 10.1016/j.jamda.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/01/2023] [Accepted: 03/12/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES Older adults represent more than 50% of trauma admissions in many high-income countries. Furthermore, they are at increased risk for complications, resulting in worse health outcomes than younger adults and a significant health care utilization burden. Quality indicators (QIs) are used to assess the quality of care in trauma systems, but few QIs reflect responses to older patients' specific needs. We aimed to (1) identify QIs used to assess acute hospital care for injured older patients, (2) assess support for identified QIs and, (3) identify gaps in existing QIs. DESIGN Scoping review of the scientific and gray literature. METHODS Selection and data extraction were performed by 2 independent reviewers. The level of support was assessed by the number of sources reporting QIs and whether they were developed according to scientific evidence, expert consensus, and patients' perspectives. RESULTS Of 10,855 identified studies, 167 were eligible. Among 257 different QIs identified, 52% were hip fracture specific. Gaps were identified for head injuries, rib, and pelvic ring fractures. Although 61% of QIs assessed care processes, 21% and 18% focused on structures and outcomes, respectively. Although most QIs were based on literature reviews and/or expert consensus, patients' perspective was rarely accounted for. The 15 QIs with the highest level of support included minimum time between emergency department arrival and ward admission, minimum time to surgery for fractures, assessment by a geriatrician, orthogeriatric review for hip fracture patients, delirium screening, prompt and appropriate analgesia, early mobilizations, and physiotherapy. CONCLUSION AND IMPLICATIONS Multiple QIs were identified, but their level of support was limited, and important gaps were identified. Future work should focus on achieving consensus for a set of QIs to assess the quality of trauma care to older adults. Such QIs could be used for quality improvement and ultimately improve outcomes for injured older adults.
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Affiliation(s)
- Marianne Giroux
- Faculté de médecine, Université Laval, Québec City, Quebec, Canada; Centre de recherche du CHU de Québec-Université Laval - Axe Santé des Populations et pratiques optimales en santé, Quebec City, Quebec, Canada.
| | - Marie-Josée Sirois
- Faculté de médecine, Université Laval, Québec City, Quebec, Canada; Centre de recherche du CHU de Québec-Université Laval - Axe Santé des Populations et pratiques optimales en santé, Quebec City, Quebec, Canada; Centre de recherche en santé durable VITAM - Centre intégré de santé et service sociaux de la capitale nationale, Quebec City, Quebec, Canada
| | - Marc-Aurèle Gagnon
- Centre de recherche du CHU de Québec-Université Laval - Axe Santé des Populations et pratiques optimales en santé, Quebec City, Quebec, Canada
| | - Marcel Émond
- Faculté de médecine, Université Laval, Québec City, Quebec, Canada; Centre de recherche du CHU de Québec-Université Laval - Axe Santé des Populations et pratiques optimales en santé, Quebec City, Quebec, Canada; Centre de recherche en santé durable VITAM - Centre intégré de santé et service sociaux de la capitale nationale, Quebec City, Quebec, Canada
| | - Méanie Bérubé
- Centre de recherche du CHU de Québec-Université Laval - Axe Santé des Populations et pratiques optimales en santé, Quebec City, Quebec, Canada; Faculty of Nursing, Université Laval, Québec City, Quebec, Canada
| | - Michèle Morin
- Faculté de médecine, Université Laval, Québec City, Quebec, Canada; Centre de recherche du CISSS de Chaudière-Appalaches, Lévis, Québec, Canada
| | - Lynne Moore
- Faculté de médecine, Université Laval, Québec City, Quebec, Canada; Centre de recherche du CHU de Québec-Université Laval - Axe Santé des Populations et pratiques optimales en santé, Quebec City, Quebec, Canada
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Schults JA, Rickard CM, Charles K, Rahiman S, Millar J, Baveas T, Long D, Kleidon TM, Macfarlane F, Mehta NM, Runnegar N, Hall L. Quality measurement and surveillance platforms in critically ill children: A scoping review. Aust Crit Care 2022:S1036-7314(22)00097-2. [PMID: 36117039 DOI: 10.1016/j.aucc.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/24/2022] [Accepted: 07/31/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND/AIM The objective of this study was to describe current surveillance platforms which support routine quality measurement in paediatric critical care. METHOD Scoping review. The search strategy consisted of a traditional database and grey literature search as well as expert consultation. Surveillance platforms were eligible for inclusion if they collected measures of quality in critically ill children. RESULTS The search strategy identified 21 surveillance platforms, collecting 57 unique outcome (70%), process (23%), and structural (7%) quality measures. Hospital-associated infections were the most commonly collected outcome measure across all platforms (n = 11; 52%). In general, case definitions were not harmonised across platforms, with the exception of nationally mandated hospital-associated infections (e.g., central line-associated blood stream infection). Data collection relied on manual coding. Platforms typically did not provide an evidence-based rationale for measures collected, with no identifiable reports of co-designed, consensus-derived measures or consumer involvement in measure selection or prioritisation. CONCLUSIONS Quality measurement in critically ill children lacks uniformity in definition which limits local and international benchmarking. Current surveillance activities for critically ill children focus heavily on outcome measurement, with process, structural, and patient-reported measures largely overlooked. Long-term outcome measures were not routinely collected. Harmonisation of paediatric intensive care unit quality measures is needed and can be achieved using prioritisation and consensus/co-design methods.
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Affiliation(s)
- Jessica A Schults
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia; Metro North Hospital and Health Service, Queensland, Australia; Child Health Research Centre, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia; School of Nursing and Midwifery Griffith University, Queensland, Australia; Paediatric Intensive Care Unit Queensland Children's Hospital, South Brisbane, Queensland, Australia.
| | - Claire M Rickard
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia; Metro North Hospital and Health Service, Queensland, Australia; School of Nursing and Midwifery Griffith University, Queensland, Australia
| | - Karina Charles
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia; Child Health Research Centre, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia; School of Nursing and Midwifery Griffith University, Queensland, Australia; Paediatric Intensive Care Unit Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Sarfaraz Rahiman
- Paediatric Intensive Care Unit Queensland Children's Hospital, South Brisbane, Queensland, Australia; School of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Johnny Millar
- Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, Australia
| | - Thimitra Baveas
- Paediatric Intensive Care Unit Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Debbie Long
- Paediatric Intensive Care Unit Queensland Children's Hospital, South Brisbane, Queensland, Australia; School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Tricia M Kleidon
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia; School of Nursing and Midwifery Griffith University, Queensland, Australia; Department of Anaesthesia and Pain Management, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Fiona Macfarlane
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Nilesh M Mehta
- Perioperative & Critical Care Center for Outcomes Research (PC-CORE), USA; Department of Anesthesiology, Critical Care & Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, USA; Harvard Medical School, Boston, USA
| | - Naomi Runnegar
- School of Medicine, University of Queensland, St Lucia, Queensland, Australia; Infection Management, Princess Alexandra Hospital, Woolloongabba, Qld, Australia
| | - Lisa Hall
- School of Public Health, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
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Martinez-Carranza N, Lindqvist K, Modig K, Hedström M. Factors associated with non-walking 4 months after hip fracture. A prospective study of 23,759 fractures. Injury 2022; 53:2180-2183. [PMID: 35307165 DOI: 10.1016/j.injury.2021.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 10/07/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Despite advances in new surgical techniques and improvements in medical care of the last decades a considerable number of patients will not regain their ability to walk after a hip fracture. AIMS To further identify risk factors associated with non-walking 4-months after a hip fracture. MATERIAL AND METHODS Register-based, longitudinal study with a 4-month follow-up. The collected data from the Swedish hip fracture registry, RIKSHÖFT, contained all hip fracture between 201301-01-2015-12-31 in Sweden. All patients older than 50 years with a non-pathological fracture and who were able to walk before the fracture were included. The association of sex, age, general health, dementia and type of discharge with complete loss of walking after a hip fracture were investigated using a multivariate analysis. RESULTS Included were 23,759 patients. At the 4-month follow-up, 10% were unable to walk. Twenty-five per cent of patients with dementia lost their ability to walk compared to 7% of those with no cognitive dysfunction. Adjusted odds ratio (OR) for factors associated with loss of walking ability were; discharge to institutionalized care rather than their own home or a rehabilitation unit (OR=1.91; 95% CI=1.67-2.18), dementia (OR=1.80; 95% CI=1.57-2.06), male gender (OR=1.59; 95% CI=1.40-1.81) and ASA score grade III-V (OR=1.37; 95% CI=1.20-1.55) but not age (OR=1.01; 95% CI=1.00-1.02). CONCLUSIONS An important factor associated with a complete loss of walking ability after a hip fracture is the discharge to institutionalized care. This factor might be influenced either by favouring rehabilitation units or by improving the rehabilitation protocols.
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Affiliation(s)
- N Martinez-Carranza
- Department of, Institution of Clinical Sciences, Intervention and Technology (CLINTEC). Karolinska Institutet, Stockholm, Sweden; Division of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
| | - K Lindqvist
- Department of, Institution of Clinical Sciences, Intervention and Technology (CLINTEC). Karolinska Institutet, Stockholm, Sweden
| | - K Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet
| | - M Hedström
- Division of Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
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Frenkel Rutenberg T, Aizer A, Levi A, Naftali N, Zeituni S, Velkes S, Aka Zohar A. Antibiotic prophylaxis as a quality of care indicator: does it help in the fight against surgical site infections following fragility hip fractures? Arch Orthop Trauma Surg 2022; 142:239-245. [PMID: 33216182 DOI: 10.1007/s00402-020-03682-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 11/04/2020] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Fragility hip fractures are associated with increased morbidity, mortality, and costs. To improve patient care, quality indicator programs were introduced. Yet, the efficacy of these programs and specific quality indicators are questioned. We aimed to determine whether defining prophylactic pre-surgical antibiotic treatment as a quality indicator affected hip fracture outcomes. MATERIALS AND METHODS A retrospective study comparing consecutive patients, 65 years and older, who were operated for fragility hip fractures between 01/01/2011 and 30/06/2016, before and after the prophylactic pre-surgical antibiotic treatment quality indicator, which was introduced in 01/2014. Primary outcomes were 1-year surgical site infections (SSI). Secondary outcomes were meeting the quality index and mortality rates, either within a hospital or during the first post-operative year. RESULTS 904 patients, ages 82.5 ± 7.2 years were operated for fragility hip fractures. 403 patients presented before the antibiotic prophylaxis quality indicator, and 501 following its administration. Patients demographics were comparable. In the pre-quality indicator period, documentation of prophylactic antibiotic treatment was lacking. Only 19.6% had a record for antibiotic administration in their surgical records and for merely 10.4% the type of antibiotic was stated. However, in the post-quality indicator period, 97.0% of patients had a registered prophylactic antibiotic regimen in the hour preceding the surgical incision (p < 0.001). Post-operative SSI rates were equivalent, and as were in-hospital infections, mortality and recurrent hospitalizations CONCLUSIONS: The introduction of the pre-operative antibiotic treatment quality indicator increased the documentation of antibiotic administration yet failed to influence the incidence of post-operative orthopaedic and medical infections in fragility hip fracture patients.
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Affiliation(s)
- Tal Frenkel Rutenberg
- Orthopedic Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Aviv University, Tel Aviv, Israel.
| | - Anat Aizer
- Department of Management, Bar Ilan University, Public Health MHA Program, Ramat Gan, Israel
| | - Avraham Levi
- Department of Management, Bar Ilan University, Public Health MHA Program, Ramat Gan, Israel
| | - Noa Naftali
- Department of Management, Bar Ilan University, Public Health MHA Program, Ramat Gan, Israel
| | - Shelly Zeituni
- Department of Management, Bar Ilan University, Public Health MHA Program, Ramat Gan, Israel
| | - Steven Velkes
- Orthopedic Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Aviv University, Tel Aviv, Israel
| | - Anat Aka Zohar
- Department of Management, Bar Ilan University, Public Health MHA Program, Ramat Gan, Israel
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Sermon A, Slock C, Coeckelberghs E, Seys D, Panella M, Bruyneel L, Nijs S, Akiki A, Castillon P, Chipperfield A, El Attal R, Foss NB, Frihagen F, Gerich TG, Gümbel D, Kanakaris N, Kristensen MT, Malchau I, Palm H, Pape HC, Vanhaecht K. Quality indicators in the treatment of geriatric hip fractures: literature review and expert consensus. Arch Osteoporos 2021; 16:152. [PMID: 34625842 DOI: 10.1007/s11657-021-00995-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/29/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Even though hip fracture care pathways have evolved, mortality rates have not improved during the last 20 years. This finding together with the increased frailty of hip fracture patients turned hip fractures into a major public health concern. The corresponding development of an indicator labyrinth for hip fractures and the ongoing practice variance in Europe call for a list of benchmarking indicators that allow for quality improvement initiatives for the rapid recovery of fragile hip fractures (RR-FHF). The purpose of this study was to identify quality indicators that assess the quality of in-hospital care for rapid recovery of fragile hip fracture (RR-FHF). METHODS A literature search and guideline selection was conducted to identify recommendations for RR-FHF. Recommendations were categorized as potential structure, process, and outcome QIs and subdivided in-hospital care treatment topics. A list of structure and process recommendations that belongs to care treatment topics relevant for RR-FHF was used to facilitate extraction of recommendations during a 2-day consensus meeting with experts (n = 15) in hip fracture care across Europe. Participants were instructed to select 5 key recommendations relevant for RR-FHF for each part of the in-hospital care pathway: pre-, intra-, and postoperative care. RESULTS In total, 37 potential QIs for RR-FHF were selected based on a methodology using the combination of high levels of evidence and expert opinion. The set consists of 14 process, 13 structure, and 10 outcome indicators that cover the whole perioperative process of fragile hip fracture care. CONCLUSION We suggest the QIs for RR-FHF to be practice tested and adapted to allow for intra-hospital longitudinal follow-up of the quality of care and for inter-hospital and cross-country benchmarking and quality improvement initiatives.
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Affiliation(s)
- An Sermon
- KU Leuven, Leuven, Belgium.,Traumatology Department at University Hospitals Leuven, Leuven, Belgium
| | | | - Ellen Coeckelberghs
- Leuven Institute for Healthcare Policy, Leuven, KU, Belgium.,European Pathway Association, Leuven, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy, Leuven, KU, Belgium
| | - Massimiliano Panella
- European Pathway Association, Leuven, Belgium.,Università Degli Studi del Piemonte Orientale "Amedeo Avogadro", Novara, Italy
| | - Luk Bruyneel
- Leuven Institute for Healthcare Policy, Leuven, KU, Belgium
| | | | - Alain Akiki
- Hôpital Riviera Chablais, Rennaz, Switzerland
| | - Pablo Castillon
- Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, España.,Universitat Autònoma de Barcelona (UAB), Bellaterra, Barcelona, España
| | - Alex Chipperfield
- Consultant Trauma and Orthopaedic Surgeon, East Kent Hospitals NHS Trust, Kent, UK
| | - René El Attal
- Klinik für Orthopädie und Unfallchirurgie, Sporttraumatologie, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Nicolai Bang Foss
- Departments of Anaesthesia and Intensive Care, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Frede Frihagen
- Orthopaedic Department, Østfold Hospital Trust, Grålum, Norway.,Associate Professor, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torsten G Gerich
- Head of Orthopaedic Trauma, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Denis Gümbel
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany.,Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
| | - Nikolaos Kanakaris
- Leeds Major Trauma Centre, Leeds Teaching Hospitals NHS Trust, Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| | - Morten Tange Kristensen
- Departments of Physiotherapy and Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Hvidovre, Denmark.,Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg-Frederiksberg and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Henrik Palm
- Head of Department, Department of Orthopedics, Copenhagen University Hospital Bispebjerg, Bispebjerg, Denmark
| | - Hans-Christoph Pape
- Department of Trauma, University of Zurich, Universitäts Spital Zurich, Zurich, Switzerland
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Leuven, KU, Belgium. .,European Pathway Association, Leuven, Belgium. .,Department of Quality, University Hospitals Leuven, Leuven, Belgium.
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9
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Nursing in the Orthogeriatric Setting. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/978-3-030-48126-1_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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10
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van Voorden TAJ, den Hartog D, Soesman NMR, Jakma TSC, Waleboer M, Staarink M, Bruijninckx MMM, Nijman F, Knops SP, Lieshout EMMV, Schep NWL. Effect of the Dutch Hip Fracture Audit implementation on mortality, length of hospital stay and time until surgery in elderly hip fracture patients; a multi-center cohort study. Injury 2020; 51:1038-1044. [PMID: 32115205 DOI: 10.1016/j.injury.2020.02.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/16/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND In 2040 the estimated number of people with a hip fracture in the Netherlands will be about 24,000. The medical care for this group of patients is complicated and challenging. Multidisciplinary approaches aim to improve clinical outcome. Quality indicators that gain insight in the treatment and outcome of hip fracture patients may help to optimize and monitor the standard of medical care. The Dutch Hip Fracture Audit (DHFA) is a new multidisciplinary quality indicator that is implemented in the Dutch hospitals in 2017. AIM The aim of this study was to determine the effect of the implementation of the DHFA on 30-day mortality, length of hospital stay and time until surgery in elderly with a hip fracture in the Netherlands. METHODS A multicenter retrospective comparative cohort study was conducted and data were extracted from the Dutch Nationwide Trauma Registration (LTR). Included were patients aged 60 years and older with a hip fracture (femoral neck and trochanteric) and admitted in one of the ten participating hospitals registered in 2015 and 2017. Data from 2015, before implementation of DHFA, were compared with data from 2017, when the DHFA was implemented. The primary outcome was 30-day mortality; secondary outcomes were length of hospital stay and time until surgery. Multivariable regression models were used to compare outcomes between groups. RESULTS 3808 patients were included, 1839 in the 2015 cohort and 1969 in the 2017 cohort. 29% was male; mean age 82 years. The multilevel analysis showed a positive non-significant difference between groups on the primary outcome30-day mortality (OR adjusted 1.23, 95%CI 0.93 - 1.63). The secondary outcomes length of hospital stay (adjusted effect estimates -0.002, 95%CI -0.03 - 0.03) and time until surgery (adjusted effect estimates 0.292, 95%CI -2.68 - 3.26) showed no differences between groups. CONCLUSIONS Implementation of the DHFA quality indicator does have a positive non-significant trend on 30-day mortality, but showed no impact on length of hospital stay and time until surgery. More research on relevant quality indicators seems therefore mandatory.
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Affiliation(s)
- Tea A J van Voorden
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Dennis den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Nicolaj M R Soesman
- Department of Surgery, Francisus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Tijs S C Jakma
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Marco Waleboer
- Department of Surgery, Admiraal de Ruyter Hospital, Goes, the Netherlands
| | - Maarten Staarink
- Department of Surgery, Het Van Weel-Bethesda Hospital, Dirksland, the Netherlands
| | | | - Frank Nijman
- Department of Orthopedic Surgery, ZorgSaam Zeeuws-Vlaanderen Hospital, Terneuzen, the Netherlands
| | - Simon P Knops
- Department of Surgery, Ikazia Hospital, Rotterdam, the Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Niels W L Schep
- Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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11
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Santana MJ, Ahmed S, Lorenzetti D, Jolley RJ, Manalili K, Zelinsky S, Quan H, Lu M. Measuring patient-centred system performance: a scoping review of patient-centred care quality indicators. BMJ Open 2019; 9:e023596. [PMID: 30617101 PMCID: PMC6326310 DOI: 10.1136/bmjopen-2018-023596] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The shift to the patient-centred care (PCC) model as a healthcare delivery paradigm calls for systematic measurement and evaluation. In an attempt to develop patient-centred quality indicators (PC-QIs), this study aimed to identify quality indicators that can be used to measure PCC. METHODS Design: scoping review. DATA SOURCES studies were identified through searching seven electronic databases and the grey literature. Search terms included quality improvement, quality indicators, healthcare quality and PCC. Eligibility Criteria: articles were included if they mentioned development and/or implementation of PC-QIs. DATA EXTRACTION AND SYNTHESIS extracted data included study characteristics (country, year of publication and type of study/article), patients' inclusion in the development of indicators and type of patient populations and point of care if applicable (eg, in-patient, out-patient and primary care). RESULTS A total 184 full-text peer-reviewed articles were assessed for eligibility for inclusion; of these, 9 articles were included in this review. From the non-peer-reviewed literature, eight documents met the criteria for inclusion in this study. This review revealed the heterogeneity describing and defining the nature of PC-QIs. Most PC-QIs were presented as PCC measures and identified as guidelines, surveys or recommendations, and therefore cannot be classified as actual PC-QIs. Out of 502 ways to measure PCC, only 25 were considered to be actual PC-QIs. None of the identified articles implemented the quality indicators in care settings. CONCLUSION The identification of PC-QIs is a key first step in laying the groundwork to develop evidence-based PC-QIs. Research is needed to continue the development and implementation of PC-QIs for healthcare quality improvement.
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Affiliation(s)
- Maria-Jose Santana
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sadia Ahmed
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Diane Lorenzetti
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Health Sciences Library, University of Calgary, Calgary, Alberta, Canada
| | - Rachel J Jolley
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kimberly Manalili
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sandra Zelinsky
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Hude Quan
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mingshan Lu
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Economics, University of Calgary, Calgary, Alberta, Canada
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12
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Voeten SC, Krijnen P, Voeten DM, Hegeman JH, Wouters MWJM, Schipper IB. Quality indicators for hip fracture care, a systematic review. Osteoporos Int 2018; 29:1963-1985. [PMID: 29774404 PMCID: PMC6105160 DOI: 10.1007/s00198-018-4558-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/30/2018] [Indexed: 11/26/2022]
Abstract
Quality indicators are used to measure quality of care and enable benchmarking. An overview of all existing hip fracture quality indicators is lacking. The primary aim was to identify quality indicators for hip fracture care reported in literature, hip fracture audits, and guidelines. The secondary aim was to compose a set of methodologically sound quality indicators for the evaluation of hip fracture care in clinical practice. A literature search according to the PRISMA guidelines and an internet search were performed to identify hip fracture quality indicators. The indicators were subdivided into process, structure, and outcome indicators. The methodological quality of the indicators was judged using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. For structure and process indicators, the construct validity was assessed. Sixteen publications, nine audits and five guidelines were included. In total, 97 unique quality indicators were found: 9 structure, 63 process, and 25 outcome indicators. Since detailed methodological information about the indicators was lacking, the AIRE instrument could not be applied. Seven indicators correlated with an outcome measure. A set of nine quality indicators was extracted from the literature, audits, and guidelines. Many quality indicators are described and used. Not all of them correlate with outcomes of care and have been assessed methodologically. As methodological evidence is lacking, we recommend the extracted set of nine indicators to be used as the starting point for further clinical research. Future research should focus on assessing the clinimetric properties of the existing quality indicators.
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Affiliation(s)
- S C Voeten
- Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, The Netherlands.
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
| | - P Krijnen
- Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, The Netherlands
| | - D M Voeten
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - J H Hegeman
- Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo/Hengelo, The Netherlands
| | - M W J M Wouters
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - I B Schipper
- Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, The Netherlands
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