Condorhuamán-Alvarado Patricia Ysabel, Pareja-Sierra Teresa, Muñoz-Pascual Angélica, Sáez-López Pilar, Ojeda-Thies Cristina, Alarcón-Alarcón Teresa, Cassinello-Ogea María Concepción, Pérez-Castrillón Jose Luis, Gómez-Campelo Paloma, Navarro-Castellanos Laura, Otero-Puime Ángel, González-Montalvo Juan Ignacio
Servicio de Geriatría, Hospital Universitario La Paz, Madrid, Spain.
Servicio de Geriatría, Hospital Universitario Guadalajara, Guadalajara, Spain.
Rev Esp Geriatr Gerontol. 2019 Sep-Oct;54(5):257-264. doi: 10.1016/j.regg.2019.04.001. Epub 2019 Jul 4.
The Spanish National Hip Fracture Registry (or Registro Nacional de Fractura de Cadera, RNFC) is a database of hip fracture patients admitted to Spanish hospitals. Its goals include assessment and continuous improvement of the care process.
To (1) establish a series of indicators, (2) evaluate their initial fulfillment, (3) propose quality standards, (4) suggest recommendations to facilitate standards compliance, and (5) monitor the indicators.
The indicators fulfilled the criteria of (1) evaluating the process or outcome, (2) being clinically relevant for patients, (3) being modifiable through changes in healthcare practice, and (4) being considered important by the RNFC participants. The first quartile obtained by the group of hospitals in each of the respective variables was proposed as the standard. The Indicators Advisory Committee (IAC) elaborated a list of recommendations for each indicator, based on the available evidence.
Seven indicators were chosen. These indicators (its baseline compliance vs. the standard to be reached, respectively) were: the proportion of patients receiving surgery within 48h (44% vs. 63%), mobilized the first postoperative day (56% vs. 86%), with antiosteoporotic medication at discharge (32% vs. 61%), with calcium supplements at discharge (46% vs. 77%), with vitamin D supplements at discharge (67% vs. 92%), who developed pressure ulcers during hospitalization (7.2% vs. 2.1%) and with independent mobility at 30 days (58% vs. 70%). The IAC has established 25 recommendations for improving care.
The indicators and standards chosen are presented, as well as the list of recommendations. This process completes the first step to improve quality of care. The results will be evaluated 6 months after implementing the recommendations.
西班牙国家髋部骨折登记处（或Registro Nacional de Fractura de Cadera，RNFC）是西班牙医院收治的髋部骨折患者的数据库。其目标包括评估和持续改进护理流程。
（1）建立一系列指标，（2）评估其初始达成情况，（3）提出质量标准，（4）提出促进标准合规的建议，以及（5）监测这些指标。
这些指标符合以下标准：（1）评估过程或结果，（2）对患者具有临床相关性，（3）可通过医疗实践的改变进行调整，以及（4）被RNFC参与者认为很重要。各医院组在各自变量中获得的第一个四分位数被提议作为标准。指标咨询委员会（IAC）根据现有证据为每个指标制定了一份建议清单。
选择了七个指标。这些指标（其基线合规率与要达到的标准分别为）：在48小时内接受手术的患者比例（44%对63%）、术后第一天活动的患者比例（56%对·86%）、出院时使用抗骨质疏松药物的患者比例（32%对61%）、出院时使用钙补充剂的患者比例（46%对77%）、出院时使用维生素D补充剂的患者比例（67%对92%）、住院期间发生压疮的患者比例（7.2%对2.1%）以及30天时具有独立活动能力的患者比例（58%对70%）。IAC已制定了25条改善护理的建议。
列出了所选的指标和标准以及建议清单。这一过程完成了提高护理质量的第一步。将在实施建议6个月后评估结果。
