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Iliopoulos E, Tosounidis T, Moustafa RM, Tilkidis F, Daskalakis I, Melissaridou D, Serenidis D, Giannatos V, Sentona M, Grammatikopoulos D, Gkiatas I, Tatani I, Zidrou C, Savvidou O, Potoupnis M, Drosos G. The use of minimum common data set in the development of the Greek Fragility Hip Fracture Registry in the Greek health care setting: the first year of its pilot implementation. Arch Osteoporos 2024; 19:85. [PMID: 39240297 DOI: 10.1007/s11657-024-01443-x] [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: 05/29/2024] [Accepted: 08/21/2024] [Indexed: 09/07/2024]
Abstract
The first Fragility Hip Fracture Registry has been established in Greece. The in-hospital length of stay was 10.8 days and was significantly influenced by the delayed surgical fixation. The increased age, the higher ASA grade, and the male gender influenced negatively the 30-day mortality, which reached 7.5%. BACKGROUND The increased incidence of fragility hip fractures constitutes a great challenge to the health care professionals and causes a significant burden on national health care systems around the globe. Fragility hip fracture registries have been used in many countries in order to document the cotemporary situation in each country and to identify potential weaknesses of the local health care systems. AIM The aim of the herein study is to present the results of the pilot implementation of the first fragility hip fracture registry in Greece, which was developed by the Greek Chapter of Fragility Fracture Network (FFN Gr), and use the neural networks in the analysis of the results. MATERIALS AND METHODS Seven orthopaedic departments from six different hospitals in Greece participated in the present pilot study. All fragility hip fractures from September 2022 until December 2023 were prospectively collected and documented using a central database. For this purpose, the 22 points of minimum common data set, proposed by the Global Fragility Fracture Network, with the addition of the 30-day mortality was used. RESULTS A total of 1009 patients who sustained a fragility hip fracture were included in the study. The mean age of the cohort was 82.2 ± 8.6 years with the majority of patients being female (72%). Sixty percent (60%) of the patients had an extracapsular hip fracture, with a mean ASA grade 2.6 ± 0.8. Intramedullary nailing and hip hemiarthroplasty were the surgical treatments of choice in the majority of extra- and intra-capsular hip fractures respectively. The mean hospital length of stay of the patients was 10.8 ± 8.5 days, and the 30-day mortality was 7.5%. The multivariant analysis revealed that the age, the ASA grade and the male gender had a significant contribution to the 30-day mortality. The neural network model had a significant under-the-curve predictive value (0.778), with age being the most important predictive factor. The length of stay was significantly influenced only by the delayed surgical fixation (more than 36 h from admission). CONCLUSIONS The present pilot study provides evidence that establishing a fragility hip fracture registry in Greece is feasible and demonstrates that the minimum common data set can be used as the base of any new registry. In Greece, patients with a fragility hip fracture stay in the hospital for approximately 11 days and have 7.5% 30-day mortality. Unfortunately, due to the logistics of the public healthcare system, they do not receive surgical fixation in a timely manner, which is a factor that negatively affects their length of in-hospital stay.
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Affiliation(s)
- Efthymios Iliopoulos
- Metabolic Disease and Fragility Fractures Unit, Academic Orthopaedic Department of General University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Theodoros Tosounidis
- Academic Department of Orthopaedic Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Reichan Molla Moustafa
- Metabolic Disease and Fragility Fractures Unit, Academic Orthopaedic Department of General University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Fotios Tilkidis
- Academic Orthopaedic Department of General University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Ioannis Daskalakis
- Academic Department of Orthopaedic Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - Dimitra Melissaridou
- 1st Academic Orthopaedic Department, 'Attikon' General University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Serenidis
- 1st Academic Orthopaedic Department, 'Attikon' General University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Giannatos
- Academic Orthopaedic Department, Patras General University Hospital, University of Patras, Patras, Greece
| | - Maria Sentona
- 2nd Orthopaedic Department, 'Papageorgiou' General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Grammatikopoulos
- 3rd Academic Orthopaedic Department, 'Papageorgiou' General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Gkiatas
- Academic Orthopaedic Department of General University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Irini Tatani
- Academic Orthopaedic Department, Patras General University Hospital, University of Patras, Patras, Greece
| | - Christianna Zidrou
- 2nd Orthopaedic Department, 'Papageorgiou' General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Olga Savvidou
- 1st Academic Orthopaedic Department, 'Attikon' General University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Potoupnis
- 3rd Academic Orthopaedic Department, 'Papageorgiou' General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Drosos
- Metabolic Disease and Fragility Fractures Unit, Academic Orthopaedic Department of General University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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Kristensen MT, Turabi R, Sheehan KJ. The relationship between extent of mobilisation within the first postoperative day and 30-day mortality after hip fracture surgery. Clin Rehabil 2024; 38:990-997. [PMID: 38347704 DOI: 10.1177/02692155241231225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To determine the association between the extent of mobilisation within the first postoperative day and 30-day mortality after hip fracture. DESIGN Cohort study. SETTING Acute orthopaedic hospital ward. PARTICIPANTS Consecutive sample of 701 patients, 65 years of age or older, 80% from own home, 49% with a trochanteric fracture, and 61% with an American Society of Anesthesiology grade > 2. INTERVENTION n/a. MAIN MEASURES Cumulated ambulation score (CAS) (0-6 points) on the first postoperative day and 30-day postoperative mortality. A CAS = 0 reflects no functional mobility (bedridden), while a CAS = 6 reflects independent out-of-bed-transfer, chair-stand, and indoor walking status. RESULTS Overall, 86% of patients were mobilised to standing or seated in chair (CAS ≥ 1) on the first postoperative day. A CAS of 0, 1-3, and 4-6 was observed for 97 (14%), 519 (74%), and 85 (12%) patients, respectively. Overall, 61 (8.7%) patients died within 30 days with the highest mortality (23.7%, n = 23) seen for those not mobilised (CAS = 0). Only one patient (1.2%) with a CAS of 4-6 points died. Cox regression analysis adjusted for age, sex, residential status, pre-fracture CAS, fracture type, and American Society of Anesthesiology grade, showed that a one-unit increase in CAS was associated with a 38% lower risk of 30-day mortality (Hazard Ratio = 0.63, 95%Confidence Interval, 0.50-0.78). CONCLUSION Mobility on the first postoperative day was associated with 30-day postoperative mortality, with a lower risk observed for those completing greater mobility. National registries may consider extending collection of mobility on the first postoperative day from a binary indicator to the CAS which captures the extent of mobility achieved.
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Affiliation(s)
- Morten Tange Kristensen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg-Frederiksberg, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Departments of Physiotherapy and Orthopedic Surgery, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Ruqayyah Turabi
- Department of Population Health Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
- Department of Physical Therapy, Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Katie J Sheehan
- Department of Population Health Sciences, Faculty of Life Sciences & Medicine, Kings College London, London, UK
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
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Wolf L, Usemann J, Collaud E, Derkenne MF, Fischer R, Hensen M, Hitzler M, Hofer M, Inci D, Irani S, Jahn K, Koutsokera A, Kusche R, Kurowski T, Latzin P, Lin D, Mioranza L, Moeller A, Mornand A, Mueller-Suter D, Murer C, Naehrlich L, Plojoux J, Regamey N, Rodriguez R, Rochat I, Sauty A, Schuurmans M, Semmler M, Trachsel D, Walter AL, Jung A. Data accuracy, consistency and completeness of the national Swiss cystic fibrosis patient registry: Lessons from an ECFSPR data quality project. J Cyst Fibros 2024; 23:506-511. [PMID: 37996316 DOI: 10.1016/j.jcf.2023.08.015] [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: 05/02/2023] [Revised: 08/03/2023] [Accepted: 08/31/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Good data quality is essential when rare disease registries are used as a data source for pharmacovigilance studies. This study investigated data quality of the Swiss cystic fibrosis (CF) registry in the frame of a European Cystic Fibrosis Society Patient Registry (ECFSPR) project aiming to implement measures to increase data reliability for registry-based research. METHODS All 20 pediatric and adult Swiss CF centers participated in a data quality audit between 2018 and 2020, and in a re-audit in 2022. Accuracy, consistency and completeness of variables and definitions were evaluated, and missing source data and informed consents (ICs) were assessed. RESULTS The first audit included 601 out of 997 Swiss people with CF (60.3 %). Data quality, as defined by data correctness ≥95 %, was high for most of the variables. Inconsistencies of specific variables were observed because of an incorrect application of the variable definition. The proportion of missing data was low with <5 % for almost all variables. A considerable number of missing source data occurred for CFTR variants. Availability of ICs varied largely between centers (10 centers had >5 % of missing documents). After providing feedback to the centers, availability of genetic source data and ICs improved. CONCLUSIONS Data audits demonstrated an overall good data quality in the Swiss CF registry. Specific measures such as support of the participating sites, training of data managers and centralized data collection should be implemented in rare disease registries to optimize data quality and provide robust data for registry-based scientific research.
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Affiliation(s)
- Lara Wolf
- Department of Respiratory Medicine, University Children's Hospital Zurich, Switzerland; Departments of Pulmonology and Paediatric Pulmonology, Cantonal Hospital Winterthur, Switzerland
| | - Jakob Usemann
- Department of Respiratory Medicine, University Children's Hospital Zurich, Switzerland; Department of Pulmonology, University Children's Hospital Basel, Switzerland
| | - Eugénie Collaud
- Department of Respiratory Medicine, University Children's Hospital Zurich, Switzerland
| | | | - Reta Fischer
- Quartier Bleu, Pulmonology Outpatient Clinic, Berne, Switzerland
| | - Maxime Hensen
- Department of Paediatrics, Cantonal Hospital Fribourg, Switzerland
| | - Michael Hitzler
- Department of Paediatric Pulmonology, Cantonal Hospital Lucerne, Switzerland
| | - Markus Hofer
- Departments of Pulmonology and Paediatric Pulmonology, Cantonal Hospital Winterthur, Switzerland
| | - Demet Inci
- Department of Respiratory Medicine, University Children's Hospital Zurich, Switzerland
| | - Sarosh Irani
- Department of Pulmonology, Cantonal Hospital Aarau, Switzerland
| | - Kathleen Jahn
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Switzerland
| | - Angela Koutsokera
- Department of Pulmonology, Lausanne University Hospital, Switzerland
| | - Rachel Kusche
- Department of Pulmonology, Cantonal Hospital Aarau, Switzerland; Department of Paediatric Pulmonology, Cantonal Hospital Aarau, Switzerland
| | - Thomas Kurowski
- Department of Pulmonology, University Hospital Zurich, Switzerland
| | - Philipp Latzin
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital Berne University Hospital, Switzerland
| | - Dagmar Lin
- Department of Pulmonology, Inselspital Berne University Hospital, Switzerland
| | - Laurence Mioranza
- Paediatric Pulmonology and Cystic Fibrosis Unit, Division of Paediatrics, Department Woman-Mother-Child, Lausanne University Hospital, Switzerland
| | - Alexander Moeller
- Department of Respiratory Medicine, University Children's Hospital Zurich, Switzerland
| | - Anne Mornand
- Department of Paediatric Pulmonology, Geneva University Hospital, Switzerland
| | | | - Christian Murer
- Department of Pulmonology, Cantonal Hospital Lucerne, Switzerland
| | - Lutz Naehrlich
- Department of Paediatrics, Justus-Liebig-University Giessen, Germany; European Cystic Fibrosis Society Patient Registry, Karup, Denmark
| | - Jérôme Plojoux
- Deparment of Pulmonology, Geneva University Hospital, Switzerland
| | - Nicolas Regamey
- Department of Paediatric Pulmonology, Cantonal Hospital Lucerne, Switzerland
| | - Romy Rodriguez
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital Berne University Hospital, Switzerland
| | - Isabelle Rochat
- Paediatric Pulmonology and Cystic Fibrosis Unit, Division of Paediatrics, Department Woman-Mother-Child, Lausanne University Hospital, Switzerland
| | - Alain Sauty
- Department of Pulmonology, Réseau Hospitalier Neuchâtelois, Switzerland
| | - Macé Schuurmans
- Department of Pulmonology, University Hospital Zurich, Switzerland
| | - Michaela Semmler
- Department of Pulmonology, Inselspital Berne University Hospital, Switzerland
| | - Daniel Trachsel
- Department of Pulmonology, University Children's Hospital Basel, Switzerland
| | - Anna-Lena Walter
- Department of Pulmonology, Cantonal Hospital St. Gallen, Switzerland
| | - Andreas Jung
- Department of Respiratory Medicine, University Children's Hospital Zurich, Switzerland; Departments of Pulmonology and Paediatric Pulmonology, Cantonal Hospital Winterthur, Switzerland; European Cystic Fibrosis Society Patient Registry, Karup, Denmark.
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Taylor ME, Ramsay N, Mitchell R, McDougall C, Harris IA, Hallen J, Ward N, Hurring S, Harvey LA, Armstrong E, Close JCT. Improving hip fracture care: A five-year review of the early contributors to the Australian and New Zealand Hip Fracture Registry. Australas J Ageing 2024; 43:31-42. [PMID: 38270215 DOI: 10.1111/ajag.13270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/29/2023] [Accepted: 11/28/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVE The aim of this study was to examine temporal trends (2016-2020) in hip fracture care in Australian and New Zealand (ANZ) hospitals that started providing patient-level data to the ANZ Hip Fracture Registry (ANZHFR) on/before 1 January 2016 (early contributors). METHODS Retrospective cohort study of early contributor hospitals (n = 24) to the ANZHFR. The study cohort included patients aged ≥50 years admitted with a low trauma hip fracture between 1 January 2016 and 31 December 2020 (n = 26,937). Annual performance against 11 quality indicators and 30- and 365-day mortality were examined. RESULTS Compared to 2016/2017, year-on-year improvements were demonstrated for preoperative cognitive assessment (2020: OR 3.57, 95% confidence interval [95% CI] 3.29-3.87) and nerve block use prior to surgery (2020: OR 4.62, 95% CI 4.17-5.11). Less consistent improvements over time from 2016/2017 were demonstrated for emergency department (ED) stay of <4 h (2017; 2020), pain assessment ≤30 min of ED presentation (2020), surgery ≤48 h (2020) and bone protection medication prescribed on discharge (2017-2020; 2020 OR 2.22, 95% CI 2.03-2.42). The odds of sustaining a hospital-acquired pressure injury increased in 2019-2020 compared to 2016. The odds of receiving an orthogeriatric model of care and being offered the opportunity to mobilise on Day 1 following surgery fluctuated. There was a reduction in 365-day mortality in 2020 compared to 2016 (OR 0.86, 95% CI 0.74-0.98), whereas 30-day mortality did not change. CONCLUSIONS Several quality indicators improved over time in early contributor hospitals. Indicators that did not improve may be targets for future care improvement activities, including considering incentivised hip fracture care, which has previously been shown to improve care/outcomes. COVID-19 and reporting practices may have impacted the study findings.
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Affiliation(s)
- Morag E Taylor
- Australian and New Zealand Hip Fracture Registry, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
- Ageing Futures Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Niamh Ramsay
- Australian and New Zealand Hip Fracture Registry, Sydney, New South Wales, Australia
| | - Rebecca Mitchell
- Australian and New Zealand Hip Fracture Registry, Sydney, New South Wales, Australia
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Catherine McDougall
- Australian and New Zealand Hip Fracture Registry, Sydney, New South Wales, Australia
- Surgical Treatment and Rehabilitation Service (STARS) and The Prince Charles Hospital, Metro North Hospital and Health Service, Queensland and Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | - Ian A Harris
- Faculty of Medicine and Health, School of Clinical Medicine, Ingham Institute for Applied Medical Research, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jamie Hallen
- Australian and New Zealand Hip Fracture Registry, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Nicola Ward
- Australian and New Zealand Hip Fracture Registry, Sydney, New South Wales, Australia
| | - Sarah Hurring
- Australian and New Zealand Hip Fracture Registry, Sydney, New South Wales, Australia
- Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand
| | - Lara A Harvey
- Australian and New Zealand Hip Fracture Registry, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Armstrong
- Australian and New Zealand Hip Fracture Registry, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jacqueline C T Close
- Australian and New Zealand Hip Fracture Registry, Sydney, New South Wales, Australia
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, School of Clinical Medicine, UNSW Sydney, Sydney, Australia
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Taylor ME, Harvey LA, Crotty M, Harris IA, Sherrington C, Close JCT. Variation in care and outcomes for people after hip fracture with and without cognitive impairment; results from the Australian and New Zealand Hip Fracture Registry. J Nutr Health Aging 2024; 28:100030. [PMID: 38388111 DOI: 10.1016/j.jnha.2023.100030] [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: 10/15/2023] [Accepted: 11/20/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND People with dementia have poorer outcomes after hip fracture and this may be due in part to variation in care. We aimed to compare care and outcomes for people with and without cognitive impairment after hip fracture. METHODS Retrospective cohort study using Australian and New Zealand Hip Fracture Registry data for people ≥50 years of age who underwent hip fracture surgery (n = 49,063). Cognitive impairment or known dementia and cognitively healthy groups were defined using preadmission cognitive status. Descriptive statistics and multivariable mixed effects models were used to compare groups. RESULTS In general, cognitively impaired people had worse care and outcomes compared to cognitively healthy older people. A lower proportion of the cognitively impaired group had timely pain assessment (≤30 min of presentation: 61% vs 68%; p < 0.0001), were given the opportunity to mobilise (89% vs 93%; p < 0.0001) and achieved day-1 mobility (34% vs 58%; p < 0.0001) than the cognitively healthy group. A higher proportion of the cognitively impaired group had delayed pain management (>30 mins of presentation: 26% vs 20%; p < 0.0001), were malnourished (27% vs 15%; p < 0.0001), had delirium (44% vs 13%; p < 0.0001) and developed a new pressure injury (4% vs 3%; p < 0.0001) than the cognitively healthy group. Fewer of the cognitively impaired group received rehabilitation (35% vs 64%; p < 0.0001), particularly patients from RACFs (16% vs 39%; p < 0.0001) and were prescribed bone protection medication on discharge (24% vs 27%; p < 0.0001). Significantly more of the cognitively impaired group had a new transfer to residential care (46% vs 11% from private residence; p < 0.0001) and died at 30-days (7% vs 3% from private residence; 15% vs 10% from RACF; both p < 0.0001). In multivariable models adjusting for covariates with facility as the random effect, the cognitively impaired group had a greater odds of being malnourished, not achieving day-1 walking, having delirium in the week after surgery, dying within 30 days, and in those from private residences, having a new transfer to a residential care facility than the cognitively healthy group. CONCLUSIONS We have identified several aspects of care that could be improved for patients with cognitive impairment - management of pain, mobility, nutrition and bone health, as well as delirium assessment, prevention and management strategies and access to rehabilitation. Further research is needed to determine whether improvements in care will reduce hospital complications and improve outcomes for people with dementia after hip fracture.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia; UNSW Ageing Futures Research Institute, Sydney, New South Wales, Australia.
| | - Lara A Harvey
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Rehabilitation Unit, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Ian A Harris
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool Hospital, Liverpool, NSW, Australia
| | - Catherine Sherrington
- Sydney Musculoskeletal Health, Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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Oosterhoff JH, Jeon S, Akhbari B, Shin D, Tobert DG, Do S, Ashkani-Esfahani S. A deep learning approach using an ensemble model to autocreate an image-based hip fracture registry. OTA Int 2023; 6:e283. [PMID: 38152438 PMCID: PMC10750455 DOI: 10.1097/oi9.0000000000000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/17/2023] [Indexed: 12/29/2023]
Abstract
Objectives With more than 300,000 patients per year in the United States alone, hip fractures are one of the most common injuries occurring in the elderly. The incidence is predicted to rise to 6 million cases per annum worldwide by 2050. Many fracture registries have been established, serving as tools for quality surveillance and evaluating patient outcomes. Most registries are based on billing and procedural codes, prone to under-reporting of cases. Deep learning (DL) is able to interpret radiographic images and assist in fracture detection; we propose to conduct a DL-based approach intended to autocreate a fracture registry, specifically for the hip fracture population. Methods Conventional radiographs (n = 18,834) from 2919 patients from Massachusetts General Brigham hospitals were extracted (images designated as hip radiographs within the medical record). We designed a cascade model consisting of 3 submodules for image view classification (MI), postoperative implant detection (MII), and proximal femoral fracture detection (MIII), including data augmentation and scaling, and convolutional neural networks for model development. An ensemble model of 10 models (based on ResNet, VGG, DenseNet, and EfficientNet architectures) was created to detect the presence of a fracture. Results The accuracy of the developed submodules reached 92%-100%; visual explanations of model predictions were generated through gradient-based methods. Time for the automated model-based fracture-labeling was 0.03 seconds/image, compared with an average of 12 seconds/image for human annotation as calculated in our preprocessing stages. Conclusion This semisupervised DL approach labeled hip fractures with high accuracy. This mitigates the burden of annotations in a large data set, which is time-consuming and prone to under-reporting. The DL approach may prove beneficial for future efforts to autocreate construct registries that outperform current diagnosis and procedural codes. Clinicians and researchers can use the developed DL approach for quality improvement, diagnostic and prognostic research purposes, and building clinical decision support tools.
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Affiliation(s)
- Jacobien H.F. Oosterhoff
- Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Department of Engineering Systems and Services, Faculty Technology Policy Management, Delft University of Technology, Delft, the Netherlands
| | - Soomin Jeon
- Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Department of Information Sciences and Mathematics, Dong-A University, Busan, South Korea
| | - Bardiya Akhbari
- Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - David Shin
- Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Daniel G. Tobert
- Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Synho Do
- Laboratory of Medical Imaging and Computation, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Soheil Ashkani-Esfahani
- Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
- Foot & Ankle Research and Innovation Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Pöyry A, Kimpimäki T, Kaartinen I, Salmi TT. Quality registry improves the data of chronic ulcers: Validation of Tampere Wound Registry. Int Wound J 2023; 20:3750-3759. [PMID: 37293796 PMCID: PMC10588319 DOI: 10.1111/iwj.14270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 06/10/2023] Open
Abstract
Quality registries are potential tools for improving health care documentation, but the quality and completeness of each registry should be ensured. This study aimed to evaluate the completion rate (completeness) and accuracy of data, first contact-to-registration time (timeliness), and case coverage of the Tampere Wound Registry (TWR) to assess whether it can be reliably used in clinical practice and for research purposes. Data from all 923 patients registered in the TWR between 5 June 2018 and 31 December 2020 were included in the analysis of data completeness, while data accuracy, timeliness and case coverage were analysed in those registered during the year 2020. In all analyses values over 80% were considered good and values over 90% excellent. The study showed that the overall completeness of the TWR was 81% and overall accuracy was 93%. Timeliness achieved 86% within the first 24 h, and case coverage was found to be 91%. When completion of seven selected variables was compared between TWR and patient medical records, the TWR was found to be more complete in five out of seven variables. In conclusion, the TWR proved to be a reliable tool for health care documentation and an even more reliable data source than patient medical records.
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Affiliation(s)
- Anna Pöyry
- Department of DermatologyTampere University HospitalTampereFinland
| | - Teija Kimpimäki
- Department of DermatologyTampere University HospitalTampereFinland
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Ilkka Kaartinen
- Department of Musculoskeletal Surgery and DiseasesTampere University HospitalTampereFinland
| | - Teea T. Salmi
- Department of DermatologyTampere University HospitalTampereFinland
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
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Palamuthusingam D, Pascoe EM, Hawley CM, Johnson DW, Ratnayake G, McDonald S, Boudville N, Jose M, Fahim M. Evaluating data quality in the Australian and New Zealand dialysis and transplant registry using administrative hospital admission datasets and data-linkage. HEALTH INF MANAG J 2023; 52:212-220. [PMID: 35695032 DOI: 10.1177/18333583221097724] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Clinical quality registries provide rich and useful data for clinical quality monitoring and research purposes but are susceptible to data quality issues that can impact their usage. Objective: This study assessed the concordance between comorbidities recorded in the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and those in state-based hospital admission datasets. Method: All patients in New South Wales, South Australia, Tasmania, Victoria and Western Australia recorded in ANZDATA as requiring chronic kidney replacement therapy (KRT) between 01/07/2000 and 31/12/2015 were linked with state-based hospital admission datasets. Coronary artery disease, diabetes mellitus, cerebrovascular disease, chronic lung disease and peripheral vascular disease recorded in ANZDATA at each annual census date were compared overall, over time and between different KRT modalities to comorbidities recorded in hospital admission datasets, as defined by the International Classification of Diseases (ICD-10-AM), using both the kappa statistic and logistic regression analysis. Results: 29, 334 patients with 207,369 hospital admissions were identified. Comparison was made at census date for every patient comparison. Overall agreement was "very good" for diabetes mellitus (92%, k = 0.84) and "poor" to "fair" (21-61%, k = 0.02-0.22) for others. Diabetes mellitus recording had the highest accuracy (sensitivity 93% (±SE 0.2) and specificity 93% (±SE 0.2)), and cerebrovascular disease had the lowest (sensitivity 54% (±SE 0.2) and specificity 21% (±SE 0.3)). The false positive rates for cerebrovascular disease, peripheral vascular disease and chronic airway disease ranged between 18 and 33%. The probability of a false positive was lowest for kidney transplant patients for all comorbidities and highest for patients on haemodialysis. Conclusions and Implications: Agreement between the clinical quality registry and hospital admission datasets was variable, with the prevalence of comorbidities being higher in ANZDATA.
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Affiliation(s)
- Dharmenaan Palamuthusingam
- Kidney Health Service, Metro North Hospitals and Health Service, Department of Nephrology, Royal Brisbane and Women's Hospital, Australia
- Faculty of Medicine, University of Queensland, Australia
- School of Medicine, Griffith University, Australia
| | - Elaine M Pascoe
- Centre for Health Services Research, University of Queensland, Australia
| | - Carmel M Hawley
- Faculty of Medicine, University of Queensland, Australia
- Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Australia
| | - David W Johnson
- Faculty of Medicine, University of Queensland, Australia
- Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Australia
- Translational Research Institute, Australia
| | - Gishan Ratnayake
- Radiation Oncology, Princess Alexandra Raymond Terrace, Australia
| | - Stephen McDonald
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Australia
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australia Health and Medical Research Institute (SAHMRI), Australia
- Adelaide Medical School, The University of Adelaide, Australia
| | - Neil Boudville
- Faculty of Medicine, University of Western Australia, Australia
- Sir Charles Gairdner Hospital, Australia
| | - Matthew Jose
- Department of Nephrology, Royal Hobart Hospital, Australia
- Faculty of Medicine, University of Tasmania, Australia
| | - Magid Fahim
- Faculty of Medicine, University of Queensland, Australia
- Metro South Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, Australia
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Australia
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Grace SL, Elashie S, Sadeghi M, Papasavvas T, Hashmi F, de Melo Ghisi G, Vargas JL, Al-Hashemi M, Turk-Adawi K. Pilot testing of the International Council of Cardiovascular Prevention and Rehabilitation Registry. Int J Qual Health Care 2023; 35:mzad050. [PMID: 37421311 PMCID: PMC10329404 DOI: 10.1093/intqhc/mzad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/06/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023] Open
Abstract
The International Council of Cardiovascular Prevention and Rehabilitation developed an International Cardiac Rehabilitation (CR) Registry (ICRR) to support CR programs in low-resource settings to optimize care provision and patient outcomes. This study assessed implementation of the ICRR, site data steward experience with on-boarding and data entry, and patient acceptability. Multimethod observational pilot involves (I) analysis of ICRR data from three centers (Iran, Pakistan, and Qatar) from inception to May 2022, (II) focus group with on-boarded site data stewards (also from Mexico and India), and (III) semistructured interviews with participating patients. Five hundred sixty-seven patients were entered. Based on volumes at each program, 85.6% of patients were entered in ICRR. 99.3% patients approached consented to participate. The average time to enter data at pre- and follow-up assessments by source was 6.8-12.6 min. Of 22 variables preprogram, completion was 89.5%. Among patients with any follow-up data, of four program-reported variables, completion was 99.0% in program completers and 51.5% in none; of 10 patient-reported variables, completion was 97.0% in program completers and 84.8% in none. The proportion of patients with any follow-up data was 84.8% in program completers, with 43.6% of noncompleters having any data entered other than completion status. Twelve data stewards participated in the focus group. Main themes were valuable on-boarding process, data entry, process of engaging patients, and benefits of participation. Thirteen patients were interviewed. Themes were good understanding of the registry, positive experience providing data, and value of lay summary and eagerness for annual assessment. Feasibility and data quality of ICRR were demonstrated.
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Affiliation(s)
- Sherry L Grace
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada
- KITE Research Institute & Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Sana Elashie
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Theodoros Papasavvas
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Farzana Hashmi
- Department of Rheumatology, Fatima Memorial Hospital & FMH College of Medicine and Dentistry, Lahore, Pakistan
| | - Gabriela de Melo Ghisi
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON M3J 1P3, Canada
| | - Jorge Lara Vargas
- Servicio de Rehabilitación Cardiaca, Departamento de Cardiocirugía, Centro Médico Nacional 20 de Noviembre, Ciudad de México 03104, México
| | - Mohammed Al-Hashemi
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Karam Turk-Adawi
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
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10
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Olona C, Pereira-Rodríguez JA, Comas J, Villalobos R, Alonso V, Amador S, Bombuy E, Mitru C, Gimeno M, López-Cano M. Data quality validation of the Spanish Incisional Hernia Surgery Registry (EVEREG): pilot study. Hernia 2023; 27:665-670. [PMID: 36964455 DOI: 10.1007/s10029-023-02782-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/14/2023] [Indexed: 03/26/2023]
Abstract
PURPOSE The Spanish Incisional Hernia Surgery Registry (EVEREG) was promoted by the Abdominal Wall Section of the Spanish Association of Surgeons, starting data collection in July 2012 and currently has more than 14,000 cases. The objective of this study was to validate the data collected through a pilot audit process. METHODS A sample of hospitals participating in the EVEREG registry since the beginning was selected. Patients registered in these centers in the 2012-2020 period were included. A stratified random sampling was carried out, with the inclusion of 10% of registered cases per center with a minimum of 20 cases per center. At each participating center, two researchers not belonging to the center undergoing the audit checked (on site or telematically) the concordance between the data in the registry and the data contained in the case history of each patient. RESULTS 330 patients have been analyzed, out of a total of 2673 registered, in 9 participating centers. The average accuracy has been 95.7%. Incorrect data 1.5% and missing data 2.3% CONCLUSION: The group of pilot hospitals from this EVERG incisional hernia surgery registry shows a very high precision of 95.7%. The confirmation of these findings in all the centers participating in the registry will make it possible to guarantee the quality of the studies made and their comparability with other similar national registries. TRIAL REGISTRATION nnTrial registration number: ClinicalTrials.gov ID:NCT03899012.
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Affiliation(s)
- C Olona
- General and Digestive Surgery Department, University Hospital of Tarragona Joan XXIII, Tarragona, Spain.
| | - J A Pereira-Rodríguez
- General and Digestive Surgery Department, University Hospital Parc de Salut Mar., Barcelona, Spain
| | - J Comas
- General Surgery Department, Hospital de Sant Joan Despí Moisés Broggi., Barcelona, Spain
| | - R Villalobos
- General and Digestive Surgery Department, University Hospital Arnau de Vilanova, Lleida, Spain
| | - V Alonso
- General and Digestive Surgery Department, Hospital Dos de Maig., Barcelona, Spain
| | - S Amador
- General and Digestive Surgery Department, Hospital General de Granollers., Barcelona, Spain
| | - E Bombuy
- General and Digestive Surgery Department, Hospital de Mataró., Barcelona, Spain
| | - C Mitru
- General and Digestive Surgery Department, University Hospital Mutua de Terrassa, Barcelona, Spain
| | - M Gimeno
- General Surgery Department, University Hospital Parc de Salut Mar., Barcelona, Spain
| | - M López-Cano
- General and Digestive Surgery Department, University Hospital Vall d'Hebron., Barcelona, Spain
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11
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Holmström B, Enlund G, Spetz P, Frostell C. The Swedish Perioperative Register: Description, validation of data mapping and utility. Acta Anaesthesiol Scand 2023; 67:233-239. [PMID: 36424870 PMCID: PMC10108284 DOI: 10.1111/aas.14174] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since 2013 surgical units in Sweden have reported procedures to the national Swedish Perioperative Register (SPOR). More than four million cases have been documented. Data consist of patient ID, type of surgery, diagnoses, time stamps during the perioperative process (from the decision to operate to the time of discharge from the postoperative recovery area) and quality measures. This article aims to describe SPOR and validate data mapping. Also, we wished to illustrate the utility of the SPOR in assessing variations in national surgical capacity during the COVID-19 pandemia years 2020-2021. METHODS After a detailed description of SPOR, we report on the validation of data performed by comparing data from local databases with data stored in the central SPOR database, assessing missing values and accuracy. Effects of the pandemic on surgical capacity were described by developing an index, based on the number of performed surgical procedures per week during four production weeks in January 2020. Subsequent weeks were then compared with this baseline. RESULTS The validation effort demonstrated nearly 100% data accuracy for the number and type of surgical procedures between local and central data. Missing data was a problem for some parameters. The number of performed surgical procedures decreased dramatically from week 11 in 2020 compared with normal production on a national basis, mainly impairing elective surgery. DISCUSSION Data validation revealed good agreement between local and central databases. The changes in national surgical capacity during the pandemic were illustrated by an index based on the reported surgical production.
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Affiliation(s)
- Björn Holmström
- Department of Medical Technology, Development and Management, Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Enlund
- Department of Anaesthesia and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Peter Spetz
- Department of Anaesthesia and Intensive Care, Mälarsjukhuset, Eskilstuna, Sweden
| | - Claes Frostell
- Department of Anaesthesia and Intensive Care, Karolinska Institute at Danderyd Hospital, Stockholm, Sweden
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12
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Lin DY, Woodman R, Oberai T, Brown B, Morrison C, Kroon H, Jaarsma R. Association of anesthesia and analgesia with long-term mortality after hip fracture surgery: an analysis of the Australian and New Zealand hip fracture registry. Reg Anesth Pain Med 2022; 48:14-21. [DOI: 10.1136/rapm-2022-103550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 09/13/2022] [Indexed: 11/04/2022]
Abstract
IntroductionHip fractures are a common frailty injury affecting a vulnerable geriatric population. It is debated if anesthetic and analgesic techniques are associated with altered risk for outcomes in hip fracture patients. This study aimed to determine the association of anesthesia and regional analgesia with all cause 12-month mortality and even longer-term mortality after hip fracture surgery in Australia and New Zealand.MethodsData from the Australian and New Zealand Hip Fracture Registry collected from 2016 to 2018, with a minimum follow-up of 12 months, were reviewed. Anesthesia type and use of regional nerve blocks were investigated. The primary outcome was all cause 12-month mortality.Results12-month mortality was 30.6% (n=5410) in a total of 17,635 patients. There was no difference in 12-month mortality between patients who received spinal or general anesthesia (p=0.238). The administration of a combination of general and spinal anesthesia for surgery to repair the fracture was an independent predictor of higher 12-month mortality (unadjusted complete case HR=1.17 (95% CI 1.04 to 1.31); p<0.001). Nerve blocks performed in both the emergency department (ED) and the operating theater (OT) were associated with reduced long-term mortality (median follow-up 21 months) with an unimputed unadjusted HR=0.86 (95% CI 0.77 to 0.96; p=0.043).ConclusionThere was no difference in the association of 12-month mortality between general and spinal anesthesia in patients undergoing hip fracture surgery. However, there was an association with a higher risk of 12-month mortality in patients who received both general and spinal anesthesia for the same surgery. Patients who received a regional nerve block in both the ED and the OT had a lower association of 12-month and longer-term mortality risk. The reasons for these findings remain unknown and should be the subject of further research investigation.
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13
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Trends in data quality and quality indicators 5 years after implementation of the Dutch Hip Fracture Audit. Eur J Trauma Emerg Surg 2022; 48:4783-4796. [PMID: 35697872 DOI: 10.1007/s00068-022-02012-y] [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: 02/21/2022] [Accepted: 05/15/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The Dutch Hip Fracture Audit (DHFA), a nationwide hip fracture registry in the Netherlands, registers hip fracture patients and aims to improve quality of care since 2016. This study shows trends in the data quality during the first 5 years of data acquisition within the DHFA, as well as trends over time for designated quality indicators (QI). METHODS All patients registered in the DHFA between 1-1-2016 and 31-12-2020 were included. Data quality-registry case coverage and data completeness-and baseline characteristics are reported. Five QI are analysed: Time to surgery < 48 h, assessment for osteoporosis, orthogeriatric co-management, registration of functional outcomes at three months, 30-day mortality. The independent association between QI results and report year was tested using mixed-effects logistic models and in the case of 30-day mortality adjusted for casemix. RESULTS In 2020, the case capture of the DHFA comprised 85% of the Dutch hip fracture patients, 66/68 hospitals participated. The average of missing clinical values was 7.5% in 2016 and 3.2% in 2020. The 3 months follow-up completeness was 36.2% (2016) and 46.8% (2020). The QI 'time to surgery' was consistently high, assessment for osteoporosis remained low, orthogeriatric co-management scores increased without significance, registration of functional outcomes improved significantly and 30-day mortality rates remained unchanged. CONCLUSION The DHFA has successfully been implemented in the past five years. Trends show improvement on data quality. Analysis of several QI indicate points of attention. Future perspectives include lowering the burden of registration, whilst improving (registration of) hip fracture patients outcomes.
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14
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Changing trends in hip fracture epidemiology in the Republic of Ireland: a follow-up study. Arch Osteoporos 2022; 17:79. [PMID: 35575820 DOI: 10.1007/s11657-022-01112-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/25/2022] [Indexed: 02/03/2023]
Abstract
A national, population-based study of hip fracture epidemiology is reported following a previously published study for the same population to ascertain the accuracy of projected incidence rates. Results suggest a decline in age-specific incidence rates in females but not males, and an over-estimation of same in the previously reported projections. PURPOSE Accurate estimates of hip fracture numbers and incidence rates are necessary for health service resource planning. A study in 2009 estimated projected figures for 2016 and 2026, for the Republic of Ireland. The purpose of the current study was to scrutinize these projections, based upon actual population and fracture statistics for the year 2016. METHODS Population data was obtained from the Central Statistics Office, and hip fracture data was obtained from the National HIPE Database for the year 2016, using similar search criteria to the previously published study. Hip fracture numbers and incidence rates were calculated. The calculated figures were compared to projected figures from the previous report. RESULTS Population projection models used in the 2009 paper accurately reflected the 2016 Irish population. For younger age groups, projected number of fractures closely estimated actual numbers, however, for those over 70 years of age, hip fracture projections overestimated the actual fracture numbers observed. There was a significant difference in the age-specific hip fracture rates in the over 70 s sub-groups compared to the published results of the 2009 study. CONCLUSIONS Hip fracture numbers continue to increase, though the age-specific incidence rates in the Republic of Ireland are reducing in the older age groups. The previously published study over-estimated hip fracture projections for the year 2016 (and potentially 2026) due to a false assumption of a stable age-specific incidence rate in the Republic of Ireland, which is in fact reducing.
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15
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Choong PFM. Hip fracture surgery: the importance of evidence‐based practice. Med J Aust 2022; 216:406-407. [DOI: 10.5694/mja2.51493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/13/2022] [Accepted: 03/22/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Peter FM Choong
- University of Melbourne Melbourne VIC
- St Vincent's Hospital Melbourne VIC
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16
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Gleich J, Fleischhacker E, Rascher K, Friess T, Kammerlander C, Böcker W, Bücking B, Liener U, Drey M, Höfer C, Neuerburg C. Increased Geriatric Treatment Frequency Improves Mobility and Secondary Fracture Prevention in Older Adult Hip Fracture Patients-An Observational Cohort Study of 23,828 Patients from the Registry for Geriatric Trauma (ATR-DGU). J Clin Med 2021; 10:jcm10235489. [PMID: 34884190 PMCID: PMC8658325 DOI: 10.3390/jcm10235489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/15/2021] [Accepted: 11/21/2021] [Indexed: 12/11/2022] Open
Abstract
Interdisciplinary orthogeriatric care of older adult hip fracture patients is of growing importance due to an ageing population, yet there is ongoing disagreement about the most effective model of care. This study aimed to compare different forms of orthogeriatric treatment, with focus on their impact on postoperative mobilization, mobility and secondary fracture prevention. In this observational cohort study, patients aged 70 years and older with a proximal femur fracture requiring surgery, were included from 1 January 2016 to 31 December 2019. Data were recorded from hospital stay to 120-day follow-up in the Registry for Geriatric Trauma (ATR-DGU), a specific designed registry for older adult hip fracture patients. Of 23,828 included patients from 95 different hospitals, 72% were female, median age was 85 (IQR 80–89) years. Increased involvement of geriatricians had a significant impact on mobilization on the first day (OR 1.1, CI 1.1–1.2) and mobility seven days after surgery (OR 1.1, CI 1.1–1.2), initiation of an osteoporosis treatment during in-hospital stay (OR 2.5, CI 2.4–2.7) and of an early complex geriatric rehabilitation treatment (OR 1.3, CI 1.2–1.4). These findings were persistent after 120 days of follow-up. Interdisciplinary treatment of orthogeriatric patients is beneficial and especially during in-patient stay increased involvement of geriatricians is decisive for early mobilization, mobility and initiation of osteoporosis treatment. Standardized treatment pathways in certified geriatric trauma departments with structured data collection in specific registries improve outcome monitoring and interpretation.
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Affiliation(s)
- Johannes Gleich
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (J.G.); (E.F.); (W.B.)
| | - Evi Fleischhacker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (J.G.); (E.F.); (W.B.)
| | - Katherine Rascher
- AUC—Academy for Trauma Surgery, 80538 Munich, Germany; (K.R.); (T.F.); (C.H.)
| | - Thomas Friess
- AUC—Academy for Trauma Surgery, 80538 Munich, Germany; (K.R.); (T.F.); (C.H.)
| | | | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (J.G.); (E.F.); (W.B.)
| | - Benjamin Bücking
- Center for Orthopedics and Trauma Surgery, DRK-Kliniken Nordhessen, 34121 Kassel, Germany;
| | - Ulrich Liener
- Department of Orthopedics and Trauma Surgery, Marienhospital, 70199 Stuttgart, Germany;
| | - Michael Drey
- Department of Medicine IV, University Hospital, LMU Munich, 80336 Munich, Germany;
| | - Christine Höfer
- AUC—Academy for Trauma Surgery, 80538 Munich, Germany; (K.R.); (T.F.); (C.H.)
| | - Carl Neuerburg
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (J.G.); (E.F.); (W.B.)
- Correspondence: ; Tel.: +49-89-4400-73500
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Lau HX, Lee SLC, Ali Y. Effectiveness of data auditing as a tool to reinforce good research data management (RDM) practice: a Singapore study. BMC Med Ethics 2021; 22:103. [PMID: 34320960 PMCID: PMC8317325 DOI: 10.1186/s12910-021-00662-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 07/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background Institutions, funding agencies and publishers are placing increasing emphasis on good research data management (RDM). RDM lapses in medical science can result in questionable data and cause the public’s confidence in the scientific community to crumble. A fledgling medical school in a young university in Singapore has mandated every funded research project to have a data management plan (DMP). However, researchers’ adherence to their DMPs was unknown until the school embarked on routine data auditing. We hypothesize that research data auditing improves RDM awareness, compliance and reception in the school. Methods We conducted surveys with research PIs and researchers before and after data auditing to evaluate differences in self-reported RDM awareness, compliance and reception. As it is mandatory to deposit research data in a central data repository system in the school, we tracked data deposition by each laboratory from 2 weeks before to 3 months after data auditing as a marker of actual RDM compliance. Results Research data auditing had an overall positive effect on self-reported RDM awareness, compliance and reception for both research PIs and researchers. Research PIs agreed more that RDM was important to scientific reproducibility, were more aware of proper RDM, had higher RDM strength in their laboratories and were more compliant with the DMP. Both research PIs and researchers believed data auditing helped them to be more compliant with data deposition in the repository. However, data auditing had no significant impact on laboratories’ data deposition rates over time, which could be due to the short sampling period. Conclusions Research PIs and researchers generally felt that data auditing was effective in improving RDM practices. It helped to evaluate their RDM practices objectively, propose corrective actions for RDM lapses and spread awareness of the university’s data management policies. Our findings corroborated other studies in medical research, geosciences, engineering and ethics that data auditing promotes good RDM practices. Hence, we recommend research institutions worldwide to adopt data auditing as a tool to reinforce research integrity. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-021-00662-y.
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Affiliation(s)
- Hui Xing Lau
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ser Lin Celine Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Yusuf Ali
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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18
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Lin X, Wallis K, Ward SA, Brodaty H, Sachdev PS, Naismith SL, Krysinska K, McNeil J, Rowe CC, Ahern S. The protocol of a clinical quality registry for dementia and mild cognitive impairment (MCI): the Australian dementia network (ADNeT) Registry. BMC Geriatr 2020; 20:330. [PMID: 32894049 PMCID: PMC7487842 DOI: 10.1186/s12877-020-01741-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 08/30/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Dementia was identified as a priority area for the development of a Clinical Quality Registry (CQR) in Australia in 2016. The Australian Dementia Network (ADNeT) Registry is being established as part of the ADNeT initiative, with the primary objective of collecting data to monitor and enhance the quality of care and patient outcomes for people diagnosed with either dementia or Mild Cognitive Impairment (MCI). A secondary aim is to facilitate the recruitment of participants into dementia research and trials. This paper describes the Registry protocol. METHODS The ADNeT Registry is a prospective CQR of patients newly diagnosed with either dementia or MCI. Eligible patients will be identified initially from memory clinics and individual medical specialists (e.g., geriatricians, psychiatrists and neurologists) involved in the diagnosis of dementia. Participants will be recruited using either an opt-out approach or waiver of consent based on three key determinants (capacity, person responsible, and communication of diagnosis). Data will be collected from four sources: participating sites, registry participants, carers, and linkage with administrative datasets. It is anticipated that the Registry will recruit approximately 10,000 participants by the end of 2023. The ADNeT registry will be developed and implemented to comply with the national operating principles for CQRs and governed by the ADNeT Registry Steering Committee. DISCUSSION The ADNeT Registry will provide important data on current clinical practice in the diagnosis, treatment and care of people with dementia and MCI in Australia as well as long-term outcomes among these people. These data will help to identify variations in clinical practice and patient outcomes and reasons underlying these variations, which in turn, will inform the development of interventions to improve care and outcomes for people with dementia and MCI.
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Affiliation(s)
- Xiaoping Lin
- School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia.
| | - Kasey Wallis
- School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Stephanie A Ward
- School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, The Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Karolina Krysinska
- School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
| | - Christopher C Rowe
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Victoria, Australia
- Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Level 3, 553 St Kilda Rd, Melbourne, Victoria, 3004, Australia
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