Queen's Hospital, Romford, UK.
Croydon University Hospital, Croydon, UK.
Osteoporos Int. 2022 Nov;33(11):2287-2292. doi: 10.1007/s00198-021-06249-y. Epub 2022 Jan 8.
Hospitals that treat more patients with osteoporotic hip fractures do not generally have better care outcomes than those that treat fewer hip fracture patients. Institutions that do look after more such patients tend, however, to more consistently perform relevant health assessments.
An inveterate link has been found between institution case volume and a wide range of clinical outcomes; for a host of medical and surgical conditions. Hip fracture patients, notwithstanding the significance of this injury, have largely been overlooked with regard to this important evaluation.
We used the UK National Hip Fracture database to determine the effect of institution hip fracture case volume on hip fracture healthcare outcomes in 2019. Using logistic regression for each healthcare outcome, we compared the best performing 50 units with the poorest performing 50 institutions to determine if the unit volume was associated with performance in each particular outcome.
There were 175 institutions with included 67,673 patients involved. The number of hip fractures between units ranged from 86 to 952. Larger units tendered to perform health assessments more consistently and mobilise patients more expeditiously post-operatively. However, patients treated at large institutions did not have any shorter lengths of stay. With regard to most other outcomes there was no association between the unit number of cases and performance; notably mortality, compliance with best practice tariff, time to surgery, the proportion of eligible patients undergoing total hip arthroplasty, length of stay delirium risk and pressure sore risk.
There is no relationship between unit volume and the majority of health care outcomes. It would seem that larger institutions tend to perform better at parameters that are dependent upon personnel numbers. However, where the outcome is contingent, even partially, on physical infrastructure capacity, there was no difference between larger and smaller units.
治疗骨质疏松性髋部骨折患者较多的医院的护理结果一般并不优于治疗髋部骨折患者较少的医院。然而，照顾更多此类患者的机构往往更一致地进行相关健康评估。
机构病例量与广泛的临床结果之间存在着长期存在的联系；对于许多医疗和手术条件。髋部骨折患者，尽管这种损伤的意义重大，但在这种重要的评估方面，他们在很大程度上被忽视了。
我们使用英国国家髋部骨折数据库来确定 2019 年机构髋部骨折病例量对髋部骨折医疗保健结果的影响。对于每个医疗保健结果，我们使用逻辑回归比较表现最好的 50 个单位和表现最差的 50 个机构，以确定单位数量是否与每个特定结果的表现相关。
有 175 个机构，共纳入 67673 名患者。各单位之间的髋部骨折数量从 86 例到 952 例不等。较大的单位往往更一致地进行健康评估，并在术后更迅速地让患者活动。然而，在大机构接受治疗的患者的住院时间并没有缩短。至于大多数其他结果，单位病例数量与表现之间没有关联；值得注意的是死亡率、遵守最佳实践关税、手术时间、符合全髋关节置换术条件的患者比例、住院谵妄风险和压疮风险。
单位数量与大多数医疗保健结果之间没有关系。似乎较大的机构在依赖人员数量的参数方面表现更好。然而，在结果部分依赖于物理基础设施能力的情况下，较大和较小的单位之间没有区别。
