Significant variation in medical costs and treatment of hip fractures among the NHS

There is significant variation in healthcare spending and care delivery across NHS hospitals in England and Wales after hip fractures, a new study aimed at understanding how hospital care affects patient outcomes and costs has revealed.

The study, led by the University of Bristol and funded by Versus Arthritis, highlights the urgent need for evidence-based quality improvement strategies to reduce healthcare spending and improve patient outcomes in the year after hip fracture. This research was published online at The Healthy Longevity Lancet today (July 10).

Hip fractures are a serious health problem, with more than 70,000 elderly people being treated in UK hospitals every year. This study highlights the high healthcare burden associated with hip fracture.

The study analyzed data from a national database for 178,757 hip fracture patients aged 60 and over in England and Wales, who experienced a hip fracture between 2016 and 2019, followed up just before the pandemic. More than one in four patients die within a year of breaking their hip.

Patients spent an average of 32 days in hospital in the year following a hip fracture, resulting in a substantial average hospitalization cost of £14,642 per patient – ​​a cost similar to that incurred in the year after a stroke, and it exceeds many common costs. cancer. But these costs vary widely between hospitals, with spending differences more than doubling, from £10,867 to £23,188 per patient, between NHS study hospitals in England and Wales.

The researchers identified that in hospitals where patients were awake and immediately after their surgery and where physiotherapy was provided seven days a week, patient costs were lower, the risk of sudden confusion (delirium) was reduced, and patients spent fewer days in the hospital. years after hip fracture.

The research further highlights the important role of orthogeriatricians – consultant geriatricians who specialize in the care of people with fractures – in the treatment of hip fractures.

Dr Petra Baji, Senior Research Associate in Health Economics at Bristol Medical School: Translational Health Sciences (THS) and first author of the paper, explained: “These findings suggest that all patients being seen by an orthogeriatrician in the first days of admission may reduce healthcare . spending £529 per patient, and reducing the chance of death by 15% in the year after hip fracture.”

Dr Rita Patel, Senior Research Fellow in Medical Statistics at Bristol and statistician for the study, added: “If a consultant orthogeriatrician attends the hospital’s clinical governance meetings a further £356 in cost savings could potentially be achieved, as well as patients spending fewer days spent in the hospital in the year following a hip fracture.

This study highlights the importance of addressing the way hospitals deliver hip fracture care to increase the effectiveness and efficiency of hip fracture services, and the need to develop evidence-based quality improvement strategies across the UK, to achieve financial savings while improving patient outcomes.

Celia Gregson, Professor of Clinical Epidemiology in the Musculoskeletal Research Unit at the University of Bristol and Chief Investigator of the study, commented, “The variation we have seen in patient outcomes and health expenditures after hip fracture is difficult to justify on clinical grounds alone, this tells us that the way we organize care delivery can be scaled up nationally.

“By prioritizing orthogeriatrician assessments, getting patients out of bed immediately after surgery, providing seven days of physiotherapy, reducing the risk of delirium for patients, and holding monthly multidisciplinary clinical governance meetings, the hospital stands to improve patient outcomes and reduce their health care expenditures. ”

Caroline Aylott, Head of Research Delivery at Versus Arthritis, said: “This study demonstrates an unacceptable state of treatment for older people with hip fractures. The findings suggest that older people have a high chance of dying within one year from a hip fracture, and that the quality of care varies widely between NHS hospitals in England and Wales.

“Because hip fractures primarily affect the elderly, many of whom live with a variety of long-term conditions, this study shows that we are not getting the care of the elderly properly. It must change.

“This study finds that better and quicker access to orthogeriatricians and fracture bridging services will not only reduce the risk of death and increase the chances of a better recovery, but also reduce NHS spending. Just weeks after the publication of the NHS workforce plan, this research provides further evidence of the urgent and urgent need for appropriate NHS resources.”

The research team has developed a potential solution, having worked with the Royal Osteoporosis Society to develop an innovative tool – the REDUCE hip fracture service implementation kit – based on their research results.

This toolkit is available free of charge to all healthcare professionals and service managers to support improving the quality of fracture service delivery in 172 acute hospital settings across England and Wales.

The study follows previous research from the REDUCE (Reducing unwarranted variety in the Delivery of high-quality hip fraCture services in England and Wales) study, which was published last year in Age and Agingjournal of the British Geriatrics Society, which focuses on the short-term outcomes of hip fracture patients.

This study was funded by Versus Arthritis (ref: 22086), the UK’s largest charity supporting people with arthritis and musculoskeletal conditions, and supported by the National Institute for Health and Care Research Bristol Biomedical Research Center (NIHR Bristol BRC).