Department of Public Health and Primary Care, KU Leuven-University of Leuven, Kapucijnenvoer 35/7001, 3000, Leuven, Belgium.
Department of Development and Regeneration, KU Leuven-University of Leuven, Herestraat 49, 3000, Leuven, Belgium.
Arch Orthop Trauma Surg. 2018 Aug;138(8):1077-1087. doi: 10.1007/s00402-018-2939-4. Epub 2018 Apr 27.
Despite the availability of clinical guidelines on the prevention and treatment of geriatric hip fractures, the percentage of recommended care received by patients is low. We conducted an importance-performance analysis for prioritizing interventions to improve the in-hospital management of these patients.
A secondary data analysis was conducted on the in-hospital treatment of 540 geriatric hip fracture patients in 34 hospitals in Belgium, Italy, and Portugal. First, we assessed the level of expert consensus on the process indicators composing international guidelines on hip fracture treatment. Second, guideline adherence on in-hospital care was evaluated within and across hospitals. Third, an importance-performance analysis was conducted, linking expert consensus to guideline adherence.
Level of expert consensus was high (above 75%) for 12 of 22 process indicators identified from the literature. There is large between and within hospital variation in guideline adherence for these indicators and for none of the 540 patients were all 22 process indicators adhered to. Importance-performance analysis demonstrated that three indicators that had a high level of expert consensus also had a high level of adherence (above 80%). Nine indicators, most of which have been previously linked to patient outcomes, had a high level of expert consensus but a consistently low level of adherence across hospitals and are identified as priority areas for improvement.
Guideline adherence for the treatment of geriatric hip fracture patients is remarkably suboptimal. Importance-performance analysis is a useful strategic approach to assist practitioners and healthcare managers to improve the quality of care.
尽管有关于老年髋部骨折预防和治疗的临床指南，但患者接受推荐护理的比例仍然很低。我们进行了一项重要性-绩效分析，以确定优先干预措施，以改善这些患者的住院管理。
对来自比利时、意大利和葡萄牙的 34 家医院的 540 例老年髋部骨折患者的住院治疗进行了二次数据分析。首先，我们评估了组成髋部骨折治疗国际指南的过程指标的专家共识水平。其次，评估了医院内和医院间的住院护理指南依从性。第三，进行了重要性-绩效分析，将专家共识与指南依从性联系起来。
从文献中确定的 22 个过程指标中，有 12 个指标的专家共识水平较高（高于 75%）。这些指标的医院间和医院内的指南依从性存在很大差异，在 540 名患者中，没有一名患者完全遵守了 22 个过程指标。重要性-绩效分析表明，三个具有较高专家共识水平的指标也具有较高的依从性（高于 80%）。九个指标具有较高的专家共识水平，但在医院间的依从性一直较低，这些指标与患者的结局有关，被确定为需要改进的优先领域。
老年髋部骨折患者的治疗指南依从性明显不理想。重要性-绩效分析是一种有用的战略方法，可以帮助医生和医疗管理人员提高护理质量。
