Department of Trauma Surgery, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333ZA, The Netherlands.
Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
Osteoporos Int. 2018 Sep;29(9):1963-1985. doi: 10.1007/s00198-018-4558-x. Epub 2018 May 17.
Quality indicators are used to measure quality of care and enable benchmarking. An overview of all existing hip fracture quality indicators is lacking. The primary aim was to identify quality indicators for hip fracture care reported in literature, hip fracture audits, and guidelines. The secondary aim was to compose a set of methodologically sound quality indicators for the evaluation of hip fracture care in clinical practice. A literature search according to the PRISMA guidelines and an internet search were performed to identify hip fracture quality indicators. The indicators were subdivided into process, structure, and outcome indicators. The methodological quality of the indicators was judged using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. For structure and process indicators, the construct validity was assessed. Sixteen publications, nine audits and five guidelines were included. In total, 97 unique quality indicators were found: 9 structure, 63 process, and 25 outcome indicators. Since detailed methodological information about the indicators was lacking, the AIRE instrument could not be applied. Seven indicators correlated with an outcome measure. A set of nine quality indicators was extracted from the literature, audits, and guidelines. Many quality indicators are described and used. Not all of them correlate with outcomes of care and have been assessed methodologically. As methodological evidence is lacking, we recommend the extracted set of nine indicators to be used as the starting point for further clinical research. Future research should focus on assessing the clinimetric properties of the existing quality indicators.
质量指标用于衡量医疗服务质量，并支持基准比较。目前缺乏对所有现有的髋部骨折质量指标的概述。主要目的是确定文献、髋部骨折审计和指南中报告的髋部骨折护理质量指标。次要目的是为临床实践中髋部骨折护理的评估制定一组方法学合理的质量指标。根据 PRISMA 指南进行文献检索和互联网搜索，以确定髋部骨折质量指标。这些指标分为过程、结构和结果指标。使用研究和评估指标评估工具（AIRE）来判断指标的方法学质量。对于结构和过程指标，评估了其构建有效性。纳入了 16 篇出版物、9 项审计和 5 项指南。总共发现了 97 个独特的质量指标：9 个结构指标、63 个过程指标和 25 个结果指标。由于缺乏关于这些指标的详细方法学信息，因此无法使用 AIRE 工具。有 7 个指标与结果测量相关。从文献、审计和指南中提取了一组 9 个质量指标。描述和使用了许多质量指标。并非所有指标都与护理结果相关，并且已经进行了方法学评估。由于缺乏方法学证据，我们建议使用提取的 9 个指标集作为进一步临床研究的起点。未来的研究应侧重于评估现有质量指标的临床计量学特性。
