Towards a ANZ Hip Fracture Registry

“Quality Care Costs Less”

Hip fractures due to falls Males and females, Australia 1999-2007 Males Females 900 800 700 600 500 400 300 200 100 0 1999–00 2000–01 2001–02 2002–03 2003–04 2004–05 2005–06 2006–07 Year of separation

Source: Bradley C. 2011. Hospitalisations due to falls by older people, Australia 2006–07. Injury research and statistics series no. 56. Cat. no. INJCAT 132. Australian Institute of Health and Welfare, Canberra.

Fragility hip fracture rates by year, WA, 1999-2009 Average yearly change: Indigenous, +6.9% (95%CI 2-12%) vs non-Indigenous, -3.6% (95%CI 3-4%)

Falls and fracture care and prevention A road map for a systematic approach Stepwise implementation based on size of impact Hip fracture patients Non-hip fragility fracture patients Individuals at high risk of 1 st fragility fracture or other injurious falls Objective 1:

Improve outcomes and improve efficiency of care after hip fractures

Objective 2:

Respond to the first fracture, prevent the second – through

Fracture Liaison Services

in acute and primary care

Objective 3:

Early intervention to restore independence – through

falls care pathway

linking acute and urgent care services to secondary falls prevention

Older people Objective 4:

Prevent frailty, preserve bone health, reduce accidents – through preserving physical activity, healthy lifestyles and reducing environmental hazards 1. DH Prevention Package for Older People

Falls and fracture care and prevention A road map for a systematic approach Stepwise implementation based on size of impact Hip fracture patients High volume, high cost Evidence around model/s of care Evidence of clinical variation in practice Evidence of sub-optimal care Evidence that data can be used to drive change Non-hip fragility fracture patients Objective 2:

Respond to the first fracture, prevent the second – through

Fracture Liaison Services

in acute and primary care

Individuals at high risk of 1 st fragility fracture or other injurious falls Objective 3:

Early intervention to restore independence – through

falls care pathway

linking acute and urgent care services to secondary falls prevention

Older people Objective 4:

Prevent frailty, preserve bone health, reduce accidents – through preserving physical activity, healthy lifestyles and reducing environmental hazards 1. DH Prevention Package for Older People

Inter-professional collaboration 2004-2007

Six Blue Book standards – monitored by NHFD

1.

2.

3.

4.

5.

6.

All patients with hip fracture should be admitted to an acute orthopaedic ward within

4 hours of presentation

All patients with hip fracture if medically fit should have

surgery within 48 hours

of admission, during normal working hours All patients with hip fracture should be assessed and cared for to

minimise risk of a pressure ulcer

All patients presenting with a fragility fracture should be managed on an orthopaedic ward with

routine access to orthogeriatric medical support from admission

All fragility fracture patients should be assessed for need of

antiresorptive therapy

to prevent future osteoporotic fractures All fragility fracture patients should be offered multidisciplinary assessment and intervention

to prevent future falls

UK NHFD Reports: 2008-2011

2011 - ALL eligible hospitals registered 191/191 Individual reports for 26 hospitals Analysis on 12,983 records from 64 hospitals Analysis on 36,556 records from 129 hospitals Analysis on 53,443 records from 176 hospitals

2011 National Hip Fracture Database Report Key metrics

Surgery within 36 hours Pre-op medical assessment Acute Length of Stay NHFD 2011 National Report. Available from www.nhfd.co.uk

Three-year trend data: 30,022 patients from 28 hospitals

Binomial test p-value <0.001 for all trends; average mortality at 30 days fell from 9.4% to 8%.

National Steering Group States and Territories LHDs Hospitals Registry National Guidelines Quality Indicators Consumer Manifesto Policy Models of Care Safety & Quality System Redesign Training / Education Resourcing models of care Local training / support Implementing best practice Measuring performance

National Hip Fracture Database

• Employs 4 people and now funded by DOH • Now has got 189 of 191 hospitals sending data (England, Wales, Northern Ireland) • Annual reporting since 2008 – 2008: ? patients from 26 hospitals – 2009: 12,983 patients from 64 hospitals – 2010: 36,556 patients from 129 hospitals – 2011: 56,000 patients from 176 hospitals

82% of predicted hip fractures

National Hip Fracture Database

• Total hip fracture records = 137,933 – Reports process indicators and case-mix adjusted outcomes (e.g. 30 day mortality) – All hospitals identified in reports

Best Practice Tariff

Best Practice Tariff

• Aims – To reduce unexplained variation in quality – To universalise best practice • Key indicators – Surgery within 36 hours – Involvement of Geriatricians • Balanced Scorecard for Hip Fractures

BPT - Payment

• All criteria must be met • Tariff – Reduced previous average payment by 10% – If criteria met – get old payment + extra – Extra = £445 • If doing 300 / yr = £134,000 = $270,000 per yr • From 2011: £890 = £267,000 = $530,000 per yr • Enough to allow investment in change, improvement and data collection

How System Works

Notify BPT compliance National Hip Fracture Database Commissioners Provide NHI and individual patient data Local Hospital Pay additional funds quarterly

Importance of “trust” in each segment of system

So why have a registry?

• • • • • •

Improve patient outcomes

–

Death, dependency and institutionalisation Safety and quality

–

e.g. timely and appropriate interventions Reduce inequalities

–

Local organisational, rural remote Driver for organisational change Use the data to shape practice Undertake additional research

Australia and New Zealand Hip Fracture Database

• • Inaugural Meeting October 2011 • Working Group Established • • Strong support from HQSC – NZ & Aust Professional Societies OA NZ & Aust

Progress with a National Registry

• • • • • • Auditing at facility level – NSW, NZ, WA Piloting at patient level in NSW WA/CMDHB have started electronic database Guidelines and quality indicators to be completed in 2012 Consumer manifesto – 2012 Conversations re build and operation of a national database

Progress

• • NZ Workshop planned May 2012 led by HQSC, NZ with NZ stakeholders participating (ACC, MOH, NHB, IT board, CNBU)

• Thank you

Discussion