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

Petra Baji; Rita Patel; Andrew Judge; Antony Johansen; Jill Griffin; Tim Chesser; Xavier L Griffin; Muhammad K Javaid; Estela C Barbosa; Yoav Ben-Shlomo; Elsa M R Marques; Celia L Gregson; Rachael Gooberman-Hill; Sarah Drew; Katie Whale; Marianne Bradshaw

doi:10.1016/S2666-7568(23)00086-7

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

Petra Baji^*, Rita Patel, Andrew Judge, Antony Johansen, Jill Griffin, Tim Chesser, Xavier L Griffin, Muhammad K Javaid, Estela C Barbosa, Yoav Ben-Shlomo, Elsa M R Marques, Celia L Gregson, Rachael Gooberman-Hill, Sarah Drew, Katie Whale, Marianne Bradshaw

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

14 Citations (Scopus)

Abstract

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 was associated with a mean cost saving of £529 (95% CI 148-910) per patient and a lower 365-day mortality (odds ratio 0·85 [95% CI 0·76-0·94]). Consultant orthogeriatrician attendance at clinical governance meetings was associated with cost savings of £356 (95% CI 188-525) and 1·47 fewer days (95% CI 0·89-2·05) in the hospital in the 365 days after hip fracture per patient. The provision of physiotherapy to patients on weekends was associated with a cost saving of £676 (95% CI 67-1285) per patient and with 2·32 fewer days (0·35-4·29) in hospital in the 365 days after hip fracture.

INTERPRETATION: Multiple, potentially modifiable hospital-level organisational factors associated with important clinical outcomes and inpatient costs were identified that should inform initiatives to improve the effectiveness and efficiency of hip fracture services.

FUNDING: Versus Arthritis.

Original language	English
Pages (from-to)	e386-e398
Journal	THE LANCET HEALTHY LONGEVITY
Volume	4
Issue number	8
Early online date	10 Jul 2023
DOIs	https://doi.org/10.1016/S2666-7568(23)00086-7
Publication status	Published - 1 Aug 2023

Bibliographical note

Funding Information:
This work was funded by Versus Arthritis (reference 22086). This study was supported by the NIHR Bristol Biomedical Research Centre, Bristol, UK, which is hosted by University Hospitals Bristol and Weston NHS Foundation Trust. MKJ is supported by the NIHR Oxford Biomedical Research Centre. YB-S is partly funded by the NIHR Applied Research Collaboration West and University of Bristol, Bristol, UK. The views expressed herein are those of the authors and not necessarily those of the NHS, NIHR, or the UK Government Department of Health and Social Care. We thank Rachael Gooberman-Hill for her valued inputs in the conception of the study, securing funding, and study organisation; Jenny Neuburger for providing code to assist with cleaning, merging, and deriving HES, Office for National Statistics, National Hip Fracture Database, and Patient Episode Database for Wales datasets; the British Orthopaedic Association who supported the REDUCE grant; and the REDUCE Study Advisory Board for their valued input.

Funding Information:
This work was funded by Versus Arthritis (reference 22086). This study was supported by the NIHR Bristol Biomedical Research Centre, Bristol, UK, which is hosted by University Hospitals Bristol and Weston NHS Foundation Trust. MKJ is supported by the NIHR Oxford Biomedical Research Centre. YB-S is partly funded by the NIHR Applied Research Collaboration West and University of Bristol, Bristol, UK. The views expressed herein are those of the authors and not necessarily those of the NHS, NIHR, or the UK Government Department of Health and Social Care. We thank Rachael Gooberman-Hill for her valued inputs in the conception of the study, securing funding, and study organisation; Jenny Neuburger for providing code to assist with cleaning, merging, and deriving HES, Office for National Statistics, National Hip Fracture Database, and Patient Episode Database for Wales datasets; the British Orthopaedic Association who supported the REDUCE grant; and the REDUCE Study Advisory Board for their valued input.

Publisher Copyright:
© 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

Research Groups and Themes

HEHP@Bristol

Keywords

hip fracture
health service improvement
length of stay
mortality
death
bed days
costs

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Cite this

Baji, P., Patel, R., Judge, A., Johansen, A., Griffin, J., Chesser, T., Griffin, X. L., Javaid, M. K., Barbosa, E. C., Ben-Shlomo, Y., Marques, E. M. R., Gregson, C. L., Gooberman-Hill, R., Drew, S., Whale, K., & Bradshaw, M. (2023). 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. THE LANCET HEALTHY LONGEVITY, 4(8), e386-e398. https://doi.org/10.1016/S2666-7568(23)00086-7

@article{651fa02396274f30a61780e659e4fb66,

title = "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",

abstract = "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 was associated with a mean cost saving of £529 (95% CI 148-910) per patient and a lower 365-day mortality (odds ratio 0·85 [95% CI 0·76-0·94]). Consultant orthogeriatrician attendance at clinical governance meetings was associated with cost savings of £356 (95% CI 188-525) and 1·47 fewer days (95% CI 0·89-2·05) in the hospital in the 365 days after hip fracture per patient. The provision of physiotherapy to patients on weekends was associated with a cost saving of £676 (95% CI 67-1285) per patient and with 2·32 fewer days (0·35-4·29) in hospital in the 365 days after hip fracture.INTERPRETATION: Multiple, potentially modifiable hospital-level organisational factors associated with important clinical outcomes and inpatient costs were identified that should inform initiatives to improve the effectiveness and efficiency of hip fracture services.FUNDING: Versus Arthritis.",

keywords = "hip fracture, health service improvement, length of stay, mortality, death, bed days, costs",

author = "Petra Baji and Rita Patel and Andrew Judge and Antony Johansen and Jill Griffin and Tim Chesser and Griffin, {Xavier L} and Javaid, {Muhammad K} and Barbosa, {Estela C} and Yoav Ben-Shlomo and Marques, {Elsa M R} and Gregson, {Celia L} and Rachael Gooberman-Hill and Sarah Drew and Katie Whale and Marianne Bradshaw",

note = "Funding Information: This work was funded by Versus Arthritis (reference 22086). This study was supported by the NIHR Bristol Biomedical Research Centre, Bristol, UK, which is hosted by University Hospitals Bristol and Weston NHS Foundation Trust. MKJ is supported by the NIHR Oxford Biomedical Research Centre. YB-S is partly funded by the NIHR Applied Research Collaboration West and University of Bristol, Bristol, UK. The views expressed herein are those of the authors and not necessarily those of the NHS, NIHR, or the UK Government Department of Health and Social Care. We thank Rachael Gooberman-Hill for her valued inputs in the conception of the study, securing funding, and study organisation; Jenny Neuburger for providing code to assist with cleaning, merging, and deriving HES, Office for National Statistics, National Hip Fracture Database, and Patient Episode Database for Wales datasets; the British Orthopaedic Association who supported the REDUCE grant; and the REDUCE Study Advisory Board for their valued input. Funding Information: This work was funded by Versus Arthritis (reference 22086). This study was supported by the NIHR Bristol Biomedical Research Centre, Bristol, UK, which is hosted by University Hospitals Bristol and Weston NHS Foundation Trust. MKJ is supported by the NIHR Oxford Biomedical Research Centre. YB-S is partly funded by the NIHR Applied Research Collaboration West and University of Bristol, Bristol, UK. The views expressed herein are those of the authors and not necessarily those of the NHS, NIHR, or the UK Government Department of Health and Social Care. We thank Rachael Gooberman-Hill for her valued inputs in the conception of the study, securing funding, and study organisation; Jenny Neuburger for providing code to assist with cleaning, merging, and deriving HES, Office for National Statistics, National Hip Fracture Database, and Patient Episode Database for Wales datasets; the British Orthopaedic Association who supported the REDUCE grant; and the REDUCE Study Advisory Board for their valued input. Publisher Copyright: {\textcopyright} 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license",

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doi = "10.1016/S2666-7568(23)00086-7",

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Baji, P , Patel, R , Judge, A, Johansen, A, Griffin, J, Chesser, T, Griffin, XL, Javaid, MK, Barbosa, EC, Ben-Shlomo, Y , Marques, EMR , Gregson, CL , Gooberman-Hill, R , Drew, S , Whale, K & Bradshaw, M 2023, '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', THE LANCET HEALTHY LONGEVITY, vol. 4, no. 8, pp. e386-e398. https://doi.org/10.1016/S2666-7568(23)00086-7

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. / Baji, Petra ; Patel, Rita ; Judge, Andrew et al.
In: THE LANCET HEALTHY LONGEVITY, Vol. 4, No. 8, 01.08.2023, p. e386-e398.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - Organisational factors associated with hospital costs and patient mortality in the 365 days following hip fracture in England and Wales (REDUCE)

T2 - a record-linkage cohort study

AU - Baji, Petra

AU - Patel, Rita

AU - Judge, Andrew

AU - Johansen, Antony

AU - Griffin, Jill

AU - Chesser, Tim

AU - Griffin, Xavier L

AU - Javaid, Muhammad K

AU - Barbosa, Estela C

AU - Ben-Shlomo, Yoav

AU - Marques, Elsa M R

AU - Gregson, Celia L

AU - Gooberman-Hill, Rachael

AU - Drew, Sarah

AU - Whale, Katie

AU - Bradshaw, Marianne

N1 - Funding Information: This work was funded by Versus Arthritis (reference 22086). This study was supported by the NIHR Bristol Biomedical Research Centre, Bristol, UK, which is hosted by University Hospitals Bristol and Weston NHS Foundation Trust. MKJ is supported by the NIHR Oxford Biomedical Research Centre. YB-S is partly funded by the NIHR Applied Research Collaboration West and University of Bristol, Bristol, UK. The views expressed herein are those of the authors and not necessarily those of the NHS, NIHR, or the UK Government Department of Health and Social Care. We thank Rachael Gooberman-Hill for her valued inputs in the conception of the study, securing funding, and study organisation; Jenny Neuburger for providing code to assist with cleaning, merging, and deriving HES, Office for National Statistics, National Hip Fracture Database, and Patient Episode Database for Wales datasets; the British Orthopaedic Association who supported the REDUCE grant; and the REDUCE Study Advisory Board for their valued input. Funding Information: This work was funded by Versus Arthritis (reference 22086). This study was supported by the NIHR Bristol Biomedical Research Centre, Bristol, UK, which is hosted by University Hospitals Bristol and Weston NHS Foundation Trust. MKJ is supported by the NIHR Oxford Biomedical Research Centre. YB-S is partly funded by the NIHR Applied Research Collaboration West and University of Bristol, Bristol, UK. The views expressed herein are those of the authors and not necessarily those of the NHS, NIHR, or the UK Government Department of Health and Social Care. We thank Rachael Gooberman-Hill for her valued inputs in the conception of the study, securing funding, and study organisation; Jenny Neuburger for providing code to assist with cleaning, merging, and deriving HES, Office for National Statistics, National Hip Fracture Database, and Patient Episode Database for Wales datasets; the British Orthopaedic Association who supported the REDUCE grant; and the REDUCE Study Advisory Board for their valued input. Publisher Copyright: © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

PY - 2023/8/1

Y1 - 2023/8/1

N2 - 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 was associated with a mean cost saving of £529 (95% CI 148-910) per patient and a lower 365-day mortality (odds ratio 0·85 [95% CI 0·76-0·94]). Consultant orthogeriatrician attendance at clinical governance meetings was associated with cost savings of £356 (95% CI 188-525) and 1·47 fewer days (95% CI 0·89-2·05) in the hospital in the 365 days after hip fracture per patient. The provision of physiotherapy to patients on weekends was associated with a cost saving of £676 (95% CI 67-1285) per patient and with 2·32 fewer days (0·35-4·29) in hospital in the 365 days after hip fracture.INTERPRETATION: Multiple, potentially modifiable hospital-level organisational factors associated with important clinical outcomes and inpatient costs were identified that should inform initiatives to improve the effectiveness and efficiency of hip fracture services.FUNDING: Versus Arthritis.

AB - 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 was associated with a mean cost saving of £529 (95% CI 148-910) per patient and a lower 365-day mortality (odds ratio 0·85 [95% CI 0·76-0·94]). Consultant orthogeriatrician attendance at clinical governance meetings was associated with cost savings of £356 (95% CI 188-525) and 1·47 fewer days (95% CI 0·89-2·05) in the hospital in the 365 days after hip fracture per patient. The provision of physiotherapy to patients on weekends was associated with a cost saving of £676 (95% CI 67-1285) per patient and with 2·32 fewer days (0·35-4·29) in hospital in the 365 days after hip fracture.INTERPRETATION: Multiple, potentially modifiable hospital-level organisational factors associated with important clinical outcomes and inpatient costs were identified that should inform initiatives to improve the effectiveness and efficiency of hip fracture services.FUNDING: Versus Arthritis.

KW - hip fracture

KW - health service improvement

KW - length of stay

KW - mortality

KW - death

KW - bed days

KW - costs

U2 - 10.1016/S2666-7568(23)00086-7

DO - 10.1016/S2666-7568(23)00086-7

M3 - Article (Academic Journal)

C2 - 37442154

SN - 2666-7568

VL - 4

SP - e386-e398

JO - THE LANCET HEALTHY LONGEVITY

JF - THE LANCET HEALTHY LONGEVITY

IS - 8

ER -

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

Abstract

Bibliographical note

Research Groups and Themes

Keywords

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