Comorbidity and Quality of In-Hospital Care for Hip Fracture Patients.
We examined whether the comorbidity burden of patients with hip fracture was associated with quality of in-hospital care reflected by fulfillment of process performance measures. Population-based cohort study using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry...
| Publicado en: | Journal of the American Medical Directors Association Vol. 23; no. 4; pp. 671 - 672 |
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| Autores principales: | , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Elsevier B.V.
Apr2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=155995204&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 155995204 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 15258610 N1L jtl: Journal of the American Medical Directors Association issn: 15258610 maglogo: N pubinfo: dt: Apr2022 vid: 23 iid: 4 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 155995204 155995204 155995204 10.1016/j.jamda.2022.01.078 155995204 ppf: 671 ppct: 1 formats: tig: atl: Comorbidity and Quality of In-Hospital Care for Hip Fracture Patients. aug: au: Schrøder, Christine K. Hjelholt, Thomas J. Møller, Henrik Madsen, Morten Pedersen, Alma B. Kristensen, Pia K. affil: Aarhus University, Aarhus, Denmark sug: subj: Comorbidity Evaluation Quality of Health Care Evaluation Hospitalization Hip Fractures Therapy Human Inpatients Prospective Studies Denmark Clinical Assessment Tools Preoperative Care Early Intervention Hip Fractures Surgery Early Ambulation Pain Measurement Physical Mobility Malnutrition Risk Factors Osteoporosis Prevention and Control Diphosphonates Therapeutic Use Accidental Falls Prevention and Control Hip Fractures Rehabilitation Treatment Outcomes Evaluation Regression Relative Risk Descriptive Statistics Hip Fractures Prognosis Confidence Intervals Comparative Studies Surgical Patients Aged Aged: 65+ years ab: We examined whether the comorbidity burden of patients with hip fracture was associated with quality of in-hospital care reflected by fulfillment of process performance measures. Population-based cohort study using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry (DMHFR). Patients aged 65 years or older with an incident hip fracture from 2014 to 2018 registered in the DMHFR (n = 31,443). Comorbidity was measured using the Charlson Comorbidity Index based on hospital diagnoses. Quality of in-hospital care was defined as fulfillment of eligible process performance measures, including preoperative optimization, early surgery, early mobilization, pain assessment, basic mobility, nutritional risk, need for anti-osteoporotic medication, fall prevention, and a post-discharge rehabilitation program, reflecting guideline-recommended in-hospital care. The outcomes were (1) an all-or-none composite measure defined as fulfillment of all relevant process performance measures, and (2) fulfillment of the individual process performance measures. Using binary regression, we calculated relative risk (RR) for the association between comorbidity level and outcomes. The overall proportion of patients with hip fracture who fulfilled the all-or-none measure was 31%. Among patients with no comorbidity, 34% fulfilled the all-or-none measure versus 29% among patients with high comorbidity (Charlson ≥ 3). This corresponds to a 15% lower chance (RR = 0.85, 95% confidence interval 0.81–0.89). Increasing comorbidity was also associated with lower fulfillment of the individual process performance measures. The largest difference was seen for preoperative optimization, early surgery, and early mobilization, where patients with high comorbidity had 6% to 11% lower chance of fulfillment of these process performance measures compared with patients without comorbidity. Increasing level of comorbidity was associated with lower quality of in-hospital care among patients with hip fracture. Our results highlight the need for tailored clinical initiatives to ensure that comorbid patients also benefit from the positive progress in hip fracture care in recent years. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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