Organisational factors associated with hospital costs and patient mortality in the 365 days following hip fracture in England and Wales (REDUCE): a record-linkage cohort study

作者：Petra Baji, Rita Patel, Andrew Judge, Antony Johansen, Jill Griffin, Tim Chesser, Xavier L Griffin, M K Javaid, Estela Capelas Barbosa, Yoav Ben‐Shlomo, Elsa Marques, Celia L. Gregson, Rachael Gooberman‐Hill, Sarah Drew, Katie Whale, Marianne Bradshaw · 发表于：The Lancet Healthy Longevity · 年份：2023 · DOI：10.1016/s2666-7568(23)00086-7 · 被引用次数：44 · 研究领域：Hip and Femur Fractures、Total Knee Arthroplasty Outcomes、Bone health and osteoporosis research

BACKGROUND: Hip fracture care delivery varies between hospitals, which might explain variations in patient outcomes and health costs. The aim of this study was to identify hospital-level organisational factors associated with long-term patient outcomes and costs after hip fracture. METHODS: REDUCE was a record-linkage cohort study in which national databases for all patients aged 60 years and older who sustained a hip fracture in England and Wales were linked with hospital metrics from 18 organisational data sources. Multilevel models identified organisational factors associated with the case-mix adjusted primary outcomes: cumulative all-cause mortality, days spent in hospital, and inpatient costs over 365 days after hip fracture. FINDINGS: Between April 1, 2016, and March 31, 2019, 178 757 patients with an index hip fracture were identified from 172 hospitals in England and Wales. 126 278 (70·6%) were female, 52 479 (29·4%) were male, and median age was 84 years (IQR 77-89) in England and 83 years (77-89) in Wales. 365 days after hip fracture, 50 354 (28·2%) patients had died. Patients spent a median 21 days (IQR 11-41) in hospital, incurring costs of £14 642 (95% CI 14 600-14 683) per patient, ranging from £10 867 (SD 5880) to £23 188 (17 223) between hospitals. 11 organisational factors were independently associated with mortality, 24 with number of days in hospital, and 25 with inpatient costs. Having all patients assessed by an orthogeriatrician within 72 h of admission ...