Oakley B, Nightingale J, Moran C G, Moppett I K
Department of Trauma and Orthopaedics, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Anaesthesia and Critical Care Section, Division of Clinical Neuroscience, Queen's Medical Centre, University of Nottingham, Nottingham, UK.
BMJ Open. 2017 Feb 6;7(2):e014190. doi: 10.1136/bmjopen-2016-014190.
To determine if the introduction of the best practice tariff (BPT) has improved survival of the elderly hip fracture population, or if achieving BPT results in improved survival for an individual.
A single university-affiliated teaching hospital.
2541 patients aged over 60 admitted with a neck of femur fracture between 2008 and 2010 and from 2012 to 2014 were included, to create two cohorts of patients, before and after the introduction of BPT. The post-BPT cohort was divided into two groups, those who achieved the criteria and those who did not.
Primary outcomes of interest were differences in mortality across cohorts. Secondary analysis was performed to identify associations between individual BPT criteria and mortality.
The introduction of BPT did not significantly alter overall 30-mortality in the hip fracture population (8.3% pre-BPT vs 10.0% post-BPT; p=0.128). Neither was there a significant reduction in length of stay (15 days (IQR 9-21) pre-BPT vs 14 days (IQR 11-22); p=0.236). However, the introduction of BPT was associated with a reduction in the time from admission to theatre (median 44 hours pre-BPT (IQR 24-44) vs 23 hours post-BPT (IQR 17-30); p<0.005). 30-day mortality in those who achieved BPT was significantly lower (6.0% vs 21.0% in those who did not achieve-BPT; p<0.005). There was a survival benefit at 1 year for those who achieved BPT (28.6% vs 42.0% did not achieve-BPT; p<0.005). Multivariate logistic regression revealed that of the BPT criteria, AMT monitoring and expedited surgery were the only BPT criteria that significantly influenced survival.
The introduction of the BPT has not led to a demonstrable improvement in outcomes at organisational level, though other factors may have confounded any benefits. However, patients where BPT criteria are met appear to have improved outcomes.
确定引入最佳实践收费标准（BPT）是否提高了老年髋部骨折患者的生存率，或者达到BPT标准是否能提高个体的生存率。
一家大学附属医院。
纳入了2008年至2010年以及2012年至2014年期间因股骨颈骨折入院的2541名60岁以上患者，以创建引入BPT之前和之后的两组患者队列。BPT实施后的队列分为两组，一组达到标准，另一组未达到标准。
感兴趣的主要结局是各队列之间死亡率的差异。进行了次要分析以确定个体BPT标准与死亡率之间的关联。
引入BPT并未显著改变髋部骨折患者的总体30天死亡率（BPT实施前为8.3%，实施后为10.0%；p=0.128）。住院时间也没有显著缩短（BPT实施前为15天（四分位间距9-21天），实施后为14天（四分位间距11-22天）；p=0.236）。然而，引入BPT与从入院到手术的时间缩短有关（BPT实施前中位数为44小时（四分位间距24-44小时），实施后为23小时（四分位间距17-30小时）；p<0.005）。达到BPT标准的患者30天死亡率显著较低（达到标准的为6.0%，未达到标准的为21.0%；p<0.005）。达到BPT标准的患者1年生存率更高（达到标准的为28.6%，未达到标准的为42.0%；p<0.005）。多因素逻辑回归显示，在BPT标准中，AMT监测和快速手术是唯一显著影响生存率的BPT标准。
引入BPT在组织层面并未带来明显的结局改善，尽管其他因素可能混淆了任何益处。然而，符合BPT标准的患者似乎结局有所改善。
