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Improving hip fracture care in Spain: evolution of quality indicators in the Spanish National Hip Fracture Registry

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Abstract

Summary

This study was carried out to analyze the evolution of the quality indicators in the Spanish National Hip Fracture Registry, after disseminating a series of recommendations based on available clinical practice guidelines to the participating hospitals. Six of the seven proposed quality indicators showed a significant improvement.

Purpose

The Spanish National Hip Fracture Registry (RNFC) arises from the need to know the process and improve the quality of care. Our goal was to analyze the changes in the RNFC’s quality indicators after an intervention based on disseminating specific recommendations among the participating hospitals, following available clinical practice guidelines.

Methods

Study comparing before and after performing an intervention in hospitals participating in the RNFC. Data from the hospitals that registered cases in 2017, and that kept registering cases in 2019. Seven quality indicators were chosen, and a standard to be achieved for each indicator was proposed. The intervention consisted in the dissemination of 25 recommendations with practical measures to improve each quality indicator, based on available clinical practice guidelines, by drafting and publishing a scientific paper and sending it via email and printed cards. Fulfilment of each quality indicator was measured after carrying out the intervention.

Results

Forty-three hospitals registered 2674 cases between January and May, 2017, and 8037 during 2019. The quality indicators chosen and the degree of compliance were (all with p<0.05): (1) surgery ≤48 h increased from 38.9 to 45.8%; (2) patients mobilised on the first postoperative day increased from 58.9 to 70.3%; (3) patients with anti-osteoporotic medication at discharge increased from 34.5 to 49.8%; (4) patients with calcium supplements at discharge increased from 48.7 to 62.8%; (5) patients with vitamin D supplements at discharge increased from 71.5 to 84.7%; (6) patients developing a grade >2 pressure ulcer during admission decreased from 6.5 to 5.0%; (7) patients able to move on their own at 1 month fell from 58.8 to 56.4%. More than 48% of hospitals improved the proposed indicators.

Conclusion

Establishing quality indicators and standards and intervening through the dissemination of specific recommendations to improve these indicators achieved an improvement in hospital performance results on a national level.

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Acknowledgements

on behalf of the participants in the Spanish National Hip Fracture Registry

Availability of data and material

The authors confirm that the data supporting the findings of this study are available within the article.

Funding

This study was funded by AMGEN SA, UCB Pharma, Abbott Laboratories and FAES Farma, as well as a research grant awarded by the Fundación Mutua Madrileña (grant number AP169672018) and by the Fundación Mapfre (Primitivo de Vega grant).

Author information

Authors and Affiliations

  1. Department of Geriatrics, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain

    Patricia Ysabel Condorhuamán-Alvarado, Teresa Alarcón-Alarcón & Juan Ignacio González-Montalvo

  2. Hospital La Paz Institute for Health Research – IdiPAZ, Hospital Universitario La Paz – Universidad Autónoma de Madrid, Madrid, Spain

    Patricia Ysabel Condorhuamán-Alvarado, Pilar Sáez-López, Alicia Gutiérrez-Misis, Teresa Alarcón-Alarcón, Paloma Gómez-Campelo, Laura Navarro-Castellanos, Ángel Otero-Puime & Juan Ignacio González-Montalvo

  3. Department of Geriatrics, Hospital Universitario Guadalajara, Guadalajara, Spain

    Teresa Pareja-Sierra

  4. Department of Geriatrics, Hospital General de Segovia, Segovia, Spain

    Angélica Muñoz-Pascual

  5. Geriatric Medicine Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain

    Pilar Sáez-López

  6. Head Coordinator of the Spanish National Hip Fracture Registry, Madrid, Spain

    Pilar Sáez-López

  7. Clinical Epidemiology Unit, Department of Preventive Medicine, Hospital Universitario La Paz, Madrid, Spain

    Jesús Diez-Sebastián

  8. Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain

    Cristina Ojeda-Thies

  9. Medicine Department, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain

    Alicia Gutiérrez-Misis, Teresa Alarcón-Alarcón & Juan Ignacio González-Montalvo

  10. Department of Anaesthesiology, Hospital Universitario Infanta Sofia, Madrid, Spain

    María Concepción Cassinello-Ogea

  11. Department of Internal Medicine, Hospital Universitario Rio Hortega, Valladolid, Spain

    Jose Luis Pérez-Castrillón

  12. “San Rafael” Centre for Health Science, Universidad Antonio de Nebrija, Madrid, Spain

    Paloma Gómez-Campelo

  13. Spanish National Hip Fracture Registry, Madrid, Spain

    Laura Navarro-Castellanos

  14. Department of Preventive Medicine, Public Health and Microbiology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain

    Ángel Otero-Puime

Authors
  1. Patricia Ysabel Condorhuamán-Alvarado
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  14. Juan Ignacio González-Montalvo
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Consortia

on behalf of the participants in the Spanish National Hip Fracture Registry

Corresponding authors

Correspondence to Patricia Ysabel Condorhuamán-Alvarado or Alicia Gutiérrez-Misis.

Ethics declarations

Ethics approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflicts of interest

The following authors have no conflicts of interest to declare: Jesús Diez Sebastián, Alicia Gutiérrez Misis, Teresa Alarcón Alarcón, Paloma Gómez Campelo, Laura Navarro Castellanos, Ángel Otero Puime. 

The following authors declare: Patricia Ysabel Condorhuamán-Alvarado has received financial support for attending symposia from Nutricia, AMGEN SA and FAES Farma; and honoraria for speaking at symposia from Nutrición Médica; none of them related with the present work.

Teresa Pareja Sierra has received financial support for attending symposia from AMGEN SA and Vifor Pharma; and honoraria for speaking at symposia from Abbott Laboratories SA; none of them related with the present work.

Angélica Muñoz Pascual has received financial support for attending symposia from Nutricia laboratories, Lilly, Abbott Laboratories SA and AMGEN SA; none of them related with the present work.

Pilar Sáez López has received financial support for attending symposia from Nutricia and Nestlé; and honoraria for speaking at symposia from Abbott Laboratories SA and AMGEN SA; none of them related with the present work.

María Concepción Cassinello Ogea has received financial support for attending symposia from CSL Behring; and honoraria for speaking at symposia from Fresenius, Baxter and Vifor Pharma; none of them related with the present work.

Jose Luis Pérez Castrillón has received financial support for attending symposia from AMGEN SA and MSD; and honoraria for speaking at symposia from AMGEN SA, MSD, Lilly and FAES Farma; none of them related with the present work.

Juan Ignacio González-Montalvo has received research grants from Nestlé Health Science and Abbott Nutrition; honoraria for speaking at symposia from Nutricia, Nestlé Health Science, AMGEN SA, and Abbott Laboratories SA; and has received financial support for educational programs from Nutricia and AMGEN SA; none of them related with the present work.

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Condorhuamán-Alvarado, P.Y., Pareja-Sierra, T., Muñoz-Pascual, A. et al. Improving hip fracture care in Spain: evolution of quality indicators in the Spanish National Hip Fracture Registry. Arch Osteoporos 17, 54 (2022). https://doi.org/10.1007/s11657-022-01084-y

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