Improving hip fracture care in Spain: evolution of quality indicators in the Spanish National Hip Fracture Registry.

This study was carried out to analyze the evolution of the quality indicators in the Spanish National Hip Fracture Registry, after disseminating a series of recommendations based on available clinical practice guidelines to the participating hospitals. Six of the seven proposed quality indicators showed a significant improvement. PURPOSE: The Spanish National Hip Fracture Registry (RNFC) arises from the need to know the process and improve the quality of care. Our goal was to analyze the changes in the RNFC's quality indicators after an intervention based on disseminating specific recommendations among the participating hospitals, following available clinical practice guidelines. METHODS: Study comparing before and after performing an intervention in hospitals participating in the RNFC. Data from the hospitals that registered cases in 2017, and that kept registering cases in 2019. Seven quality indicators were chosen, and a standard to be achieved for each indicator was proposed. The intervention consisted in the dissemination of 25 recommendations with practical measures to improve each quality indicator, based on available clinical practice guidelines, by drafting and publishing a scientific paper and sending it via email and printed cards. Fulfilment of each quality indicator was measured after carrying out the intervention. RESULTS: Forty-three hospitals registered 2674 cases between January and May, 2017, and 8037 during 2019. The quality indicators chosen and the degree of compliance were (all with p<0.05): (1) surgery ≤48 h increased from 38.9 to 45.8%; (2) patients mobilised on the first postoperative day increased from 58.9 to 70.3%; (3) patients with anti-osteoporotic medication at discharge increased from 34.5 to 49.8%; (4) patients with calcium supplements at discharge increased from 48.7 to 62.8%; (5) patients with vitamin D supplements at discharge increased from 71.5 to 84.7%; (6) patients developing a grade >2 pressure ulcer during admission decreased from 6.5 to 5.0%; (7) patients able to move on their own at 1 month fell from 58.8 to 56.4%. More than 48% of hospitals improved the proposed indicators. CONCLUSION: Establishing quality indicators and standards and intervening through the dissemination of specific recommendations to improve these indicators achieved an improvement in hospital performance results on a national level.

First proposal of quality indicators and standards and recommendations to improve the healthcare in the Spanish National Registry of Hip Fracture / Primera propuesta de indicadores y estándares de calidad y recomendaciones de mejora de la atención en el Registro Nacional de Fractura de Cadera

Background: The Spanish National Hip Fracture Registry (or Registro Nacional de Fractura de Cadera, RNFC) is a database of hip fracture patients admitted to Spanish hospitals. Its goals include assessment and continuous improvement of the care process. Objectives: To (1) establish a series of indicators, (2) evaluate their initial fulfillment, (3) propose quality standards, (4) suggest recommendations to facilitate standards compliance, and (5) monitor the indicators. Method: The indicators fulfilled the criteria of (1) evaluating the process or outcome, (2) being clinically relevant for patients, (3) being modifiable through changes in healthcare practice, and (4) being considered important by the RNFC participants. The first quartile obtained by the group of hospitals in each of the respective variables was proposed as the standard. The Indicators Advisory Committee (IAC) elaborated a list of recommendations for each indicator, based on the available evidence. Results: Seven indicators were chosen. These indicators (its baseline compliance vs. the standard to be reached, respectively) were: the proportion of patients receiving surgery within 48h (44% vs. 63%), mobilized the first postoperative day (56% vs. 86%), with antiosteoporotic medication at discharge (32% vs. 61%), with calcium supplements at discharge (46% vs. 77%), with vitamin D supplements at discharge (67% vs. 92%), who developed pressure ulcers during hospitalization (7.2% vs. 2.1%) and with independent mobility at 30 days (58% vs. 70%). The IAC has established 25 recommendations for improving care. Conclusion: The indicators and standards chosen are presented, as well as the list of recommendations. This process completes the first step to improve quality of care. The results will be evaluated 6 months after implementing the recommendations

Antecedentes: El Registro Nacional de Fractura de Cadera (RNFC) es una base de datos de pacientes con fractura de cadera ingresados en hospitales españoles. Entre sus objetivos se encuentran el conocimiento y la mejora continua del proceso asistencial. Objetivos: 1) establecer una serie de indicadores, 2) evaluar su cumplimiento inicial, 3) proponer unos estándares, 4) sugerir recomendaciones para facilitar el cumplimiento de los estándares y 5) realizar una monitorización de los indicadores. Método: Los indicadores cumplían los criterios de: 1) evaluar proceso o resultados, 2) tener relevancia clínica para los pacientes, 3) ser potencialmente modificables mediante cambios en la práctica asistencial y 4) ser considerados importantes por los participantes del RNFC. Se propuso como estándar el primer cuartil obtenido por el grupo de hospitales en cada una de las variables respectivas. El Comité de Indicadores (CI) elaboró una lista de recomendaciones basadas en la evidencia disponible. Resultados: Se eligieron 7 indicadores. Estos indicadores (con su grado de cumplimiento inicial vs. el estándar a alcanzar, respectivamente) fueron la proporción de pacientes intervenidos en menos de 48h (44 vs. 63%), levantados el primer día del postoperatorio (56 vs. 86%), con tratamiento anti-osteoporótico al alta (32 vs. 61%), con tratamiento de calcio al alta (46 vs. 77%), con tratamiento de vitamina D al alta (67 vs. 92%), que desarrollaron úlceras por presión durante la hospitalización (7,2 vs. 2,1%) y con movilidad independiente a los 30 días (58 vs. 70%). El CI ha establecido una serie de 25 recomendaciones para la mejora asistencial. Conclusión: Se presentan los indicadores y estándares elegidos, así como las recomendaciones. Este proceso completa el primer paso de mejora de calidad asistencial, cuyo resultado deberá ser evaluado tras 6 meses de implementación de las recomendaciones elegidas

First proposal of quality indicators and standards and recommendations to improve the healthcare in the Spanish National Registry of Hip Fracture.

BACKGROUND: The Spanish National Hip Fracture Registry (or Registro Nacional de Fractura de Cadera, RNFC) is a database of hip fracture patients admitted to Spanish hospitals. Its goals include assessment and continuous improvement of the care process. OBJECTIVES: To (1) establish a series of indicators, (2) evaluate their initial fulfillment, (3) propose quality standards, (4) suggest recommendations to facilitate standards compliance, and (5) monitor the indicators. METHOD: The indicators fulfilled the criteria of (1) evaluating the process or outcome, (2) being clinically relevant for patients, (3) being modifiable through changes in healthcare practice, and (4) being considered important by the RNFC participants. The first quartile obtained by the group of hospitals in each of the respective variables was proposed as the standard. The Indicators Advisory Committee (IAC) elaborated a list of recommendations for each indicator, based on the available evidence. RESULTS: Seven indicators were chosen. These indicators (its baseline compliance vs. the standard to be reached, respectively) were: the proportion of patients receiving surgery within 48h (44% vs. 63%), mobilized the first postoperative day (56% vs. 86%), with antiosteoporotic medication at discharge (32% vs. 61%), with calcium supplements at discharge (46% vs. 77%), with vitamin D supplements at discharge (67% vs. 92%), who developed pressure ulcers during hospitalization (7.2% vs. 2.1%) and with independent mobility at 30 days (58% vs. 70%). The IAC has established 25 recommendations for improving care. CONCLUSION: The indicators and standards chosen are presented, as well as the list of recommendations. This process completes the first step to improve quality of care. The results will be evaluated 6 months after implementing the recommendations.

Cambios en la percepción de los alumnos de medicina sobre la geriatría tras una rotación clínica docente / Changes in the perception of medical students towards Geriatrics after a clinical-teaching rotation

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Factores predictores de pérdida funcional al alta en ancianos hospitalizados por enfermedad aguda / Predictive factors of functional decline at hospital discharge in elderly patients hospitalised due to acute illness

Objetivo: Comparar las características basales y las encontradas durante la hospitalización como predictores de pérdida funcional al alta (PFa) en ancianos hospitalizados por enfermedad aguda. Material y métodos: Se revisaron los registros informatizados de los pacientes ingresados en una Unidad de Agudos de Geriatría de un hospital terciario durante 10 años. Se incluyeron variables demográficas, clínicas, funcionales y asistenciales. Se definió la PFa mediante la diferencia entre el índice de Barthel basal (IBp) y al alta (IBa). Se calculó el porcentaje de PFa (%PFa=(IBp−IBa/IBp)x100). Las variables asociadas a mayor %PFa en el análisis bivariante se incluyeron en modelos multivariantes de regresión logística. La capacidad predictiva de cada modelo se evaluó mediante el área bajo la curva ROC. Resultados: Los factores asociados a mayor %PFa fueron la edad avanzada, el sexo femenino, provenir de residencia, un mayor deterioro cognitivo previo y al ingreso, una mejor situación funcional previa, una peor situación funcional al ingreso, un mayor número de diagnósticos y una estancia prolongada. El área bajo la curva para los modelos predictivos de %PFa fue 0,638 (IC 95%: 0,615-0,662) en el basado en la situación previa; 0,756 (IC 95%: 0,736-0,776) en el basado en la situación durante el ingreso; y 0,952 (IC 95%: 0,944-0,959) en el basado en una combinación de ambas. Conclusiones: La valoración global de las características del paciente tanto basales como durante el ingreso tiene mayor valor en la predicción de PFa que el análisis de los factores por separado en ancianos hospitalizados por enfermedad aguda (AU)

Objective: To compare baseline characteristics and those found during hospitalisation as predictors of functional decline at discharge (FDd) in elderly patients hospitalised due to acute illness. Material and method: A review was made of the computerized records of patients admitted to a Geriatric Acute Unit of a tertiary hospital over a 10 year period. A record was made of demographic, clinical, functional and health-care variables. Functional decline at discharge (FDd) was defined by the difference between the previous Barthel Index (pBI) and the discharge Barthel Index (dBI). The percentage of FDd (%FDd=(pBI−dBI/pBI)×100) was calculated. The variables associated with greater %FDd in the bivariate analysis were included in multivariate logistic regression models. The predictive capacity of each model was assessed using the area under the ROC curve. Results: The factors associated with greater %FDd were advanced age, female gender, to live in a nursing home, cognitive impairment, better baseline functional status and worse functional status at admission, number of diagnoses, and prolonged stay. The area under the ROC curve for the predictive models of %FDd was 0.638 (95% CI: 0.615-0.662) based on the previous situation, 0.756 (95% CI: 0.736-0.776) based on the situation during admission, and 0.952 (95% CI: 0.944-0.959) based on a combination of these factors. Conclusions: The overall assessment of patient characteristics, both during admission and baseline, may have greater value in prediction of FDd than analysis of factors separately in elderly patients hospitalised due to acute illness (AU)

[Predictive factors of functional decline at hospital discharge in elderly patients hospitalised due to acute illness]. / Factores predictores de pérdida funcional al alta en ancianos hospitalizados por enfermedad aguda.

OBJECTIVE: To compare baseline characteristics and those found during hospitalisation as predictors of functional decline at discharge (FDd) in elderly patients hospitalised due to acute illness. MATERIAL AND METHOD: A review was made of the computerized records of patients admitted to a Geriatric Acute Unit of a tertiary hospital over a 10 year period. A record was made of demographic, clinical, functional and health-care variables. Functional decline at discharge (FDd) was defined by the difference between the previous Barthel Index (pBI) and the discharge Barthel Index (dBI). The percentage of FDd (%FDd=(pBI-dBI/pBI)×100) was calculated. The variables associated with greater %FDd in the bivariate analysis were included in multivariate logistic regression models. The predictive capacity of each model was assessed using the area under the ROC curve. RESULTS: The factors associated with greater %FDd were advanced age, female gender, to live in a nursing home, cognitive impairment, better baseline functional status and worse functional status at admission, number of diagnoses, and prolonged stay. The area under the ROC curve for the predictive models of %FDd was 0.638 (95% CI: 0.615-0.662) based on the previous situation, 0.756 (95% CI: 0.736-0.776) based on the situation during admission, and 0.952 (95% CI: 0.944-0.959) based on a combination of these factors. CONCLUSIONS: The overall assessment of patient characteristics, both during admission and baseline, may have greater value in prediction of FDd than analysis of factors separately in elderly patients hospitalised due to acute illness.

Mujer de 83 años con disnea y edemas en miembros inferiores / An 83 year old woman with dyspnoea and oedema of the lower limbs

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