Are process performance measures associated with clinical outcomes among patients with hip fractures? A population-based cohort study

OBJECTIVES: To examine the association between process performance measures and clinical outcome among patients with hip fracture. DESIGN: Nationwide, population-based follow-up study. SETTING: Public Danish hospitals. PARTICIPANTS: A total of 25 354 patients 65 years or older who were admitted with a hip fracture in Denmark between 2010 and 2013. INTERVENTION: The process performance measures, including systematic pain assessment, early mobilization, basic mobility assessment at arrival and at discharge, post-discharge rehabilitation program, anti-osteoporotic medication and prevention of future fall accidents measures, were analysed individually as well as an opportunity-based score defined as the proportion of all relevant performance measures fulfilled for the individual patient (0-50%, 50-75% and 75-100%). MAIN OUTCOME MEASURES: Thirty-day mortality, 30-day readmission after discharge and length of stay (LOS). RESULTS: Fulfilling 75-100% of the relevant process performance measures was associated with lower 30-day mortality (22.6% vs. 8.5%, adjusted odds ratio (OR) 0.31 (95% CI: 0.28-0.35)) and lower odds for readmission (21.7% vs. 17.4%, adjusted OR 0.78 (95% CI: 0.70-0.87)). The overall opportunity score for quality of care was not associated with LOS (adjusted OR 1.00 (95% CI: 0.98-1.04)). Mobilization within 24 h postoperatively was the process with the strongest association with lower 30-day mortality, readmission risk and shorter LOS. CONCLUSIONS: Higher quality of in-hospital care and in particular early mobilization was associated with a better clinical outcome, including lower 30-day mortality, among patients with hip fracture.