Key result
Financial incentive for early hip fracture surgery fails to increase expedited surgery rates.
Why the study?
To examine early effects of an April 2022 financial incentive in Japan for surgeries within 48 h after hip fracture in patients aged 75 and older.
Does a financial incentive for hip fracture surgery within 48 hours improve expedited surgery rates, mortality, morbidity, length of stay, and medical expenses in patients aged 75 and older?
Observational (n=82,163)
Yes
Does a financial incentive for hip fracture surgery within 48 hours improve expedited surgery rates, mortality, morbidity, length of stay, and medical expenses in patients aged 75 and older?
Relative Risk: 1.0043 (95% CI 0.9977–1.0111)
p-value: p=not significant
The introduction of a financial incentive for early hip fracture surgery in Japan did not significantly improve the rates of expedited surgery or clinical outcomes in the short term.
Financial incentives were not associated with more expedited hip fracture surgeries; leaves open whether alternative policies can improve timeliness in older adults.
OBJECTIVE: To examine the early effects of the financial incentive (FI) implemented in April 2022 in Japan for surgeries within 48 h after hip fracture (HF) in patients aged 75 and older on expedited HF surgery (EHFS), in-hospital mortality, perioperative morbidity, length of stay (LOS) and inpatient medical expenses (IMEs). STUDY SETTING AND DESIGN: We conducted a quasi-experimental study and constructed segmented regression models for controlled interrupted time-series analyses, assuming a Poisson distribution, to evaluate the slope changes (SCs) in the outcomes of interest before and after the introduction of the FI. DATA SOURCES AND ANALYTIC SAMPLE: We used Diagnosis Procedure Combination data from the Quality Indicator/Improvement Project database between 1 April 2018 and 31 March 2023. Patients aged 50 years or older who were hospitalized with a diagnosis of HF and underwent surgery for HF were included. PRINCIPAL FINDINGS: A total of 82,163 patients from 183 hospitals were included in the analyses. In the age group of 75 years and older, increasing trends in the number of EHFSs were observed even before the introduction of the FI, while before and after the introduction of the FI, none of the SCs in the monthly number of EHFSs within 2 days, within 1 day, and on the day of admission were statistically significant (incident rate ratio: 1.0043, 95% confidence interval [CI]: [0.9977-1.0111], 1.0068 [0.9987-1.0149], 1.0073 [0.9930-1.0219]). Nor were any of the SCs in in-hospital deaths, perioperative complications, LOS, and IMEs statistically significant. Additionally, there were no statistical differences in the SCs for any of the outcomes between the two age groups. CONCLUSION: This study suggested that there was no significant, short-term effect of the FI for surgeries within 48 h after HF on any of the outcomes of interest.
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Minato et al. (2024) conducted an observational in Hip fracture (n=82,163). Financial incentive for surgeries within 48 h after hip fracture vs. Before the introduction of the financial incentive was evaluated on Slope change in the monthly number of expedited hip fracture surgeries within 2 days (IRR 1.0043, 95% CI 0.9977-1.0111, p=not significant). A financial incentive for hip fracture surgery within 48 hours did not significantly change the monthly number of expedited surgeries within 2 days (IRR 1.0043; 95% CI 0.9977-1.0111).
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