Department of Orthopedic Surgery, Regional Hospital Horsens, Horsens, Denmark
Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.
BMJ Open. 2021 Dec 30;11(12):e051424. doi: 10.1136/bmjopen-2021-051424.
To characterise and quantify possible patient-related disparities in hip fracture care including temporal changes.
Population-based cohort study.
All Danish hospitals treating patients with hip fracture.
60 275 hip fracture patients from 2007 to 2016.
Quality of care was defined as fulfilment of eligible care process measures for the individual patient recommended by an expert panel. Using yearly logistic regression models, we predicted the individual patient's probability for receiving high-quality care, resulting in a distribution of adjusted probabilities based on age, sex, comorbidity, fracture type, education, family mean income, migration status, cohabitation status, employment status, nursing home residence and type of municipality. Based on the distribution, we identified best-off patients (ie, the 10% of patients with the highest probability) and worst-off patients (ie, the 10% of patients with the lowest probability). We evaluated disparities in quality of care by measuring the distance in fulfilment of outcomes between the best-off and worst-off patients.
The primary outcome was fulfilment of all-or-none, defined as receiving all relevant process measures. Secondary outcomes were fulfilment of the individual process measures including preoperative optimisation, early surgery, early mobilisation, assessment of pain, basic mobility, nutritional risk and need for antiosteoporotic medication, fall prevention and a postdischarge rehabilitation programme.
The proportion of patients receiving high-quality care varied over time for both best-off and worst-off patients. The absolute difference in percentage points between the best-off and worst-off patients for receiving all-or-none of the eligible process measures was 12 (95% CI 6 to 18) in 2007 and 23 (95% CI 19 to 28) in 2016. Disparities were consistent for a range of care processes, including assessment of pain, mobilisation within 24 hours, assessment of need for antiosteoporotic medication and nutritional risk assessment.
Disparity of care between best-off and worst-off patients remained substantial over time.
描述并量化髋部骨折治疗中可能存在的患者相关差异，包括时间变化。
基于人群的队列研究。
丹麦所有治疗髋部骨折患者的医院。
2007 年至 2016 年的 60275 例髋部骨折患者。
护理质量定义为符合专家小组推荐的个别患者的合格护理流程措施。使用每年的逻辑回归模型，我们预测个别患者接受高质量护理的概率，从而根据年龄、性别、合并症、骨折类型、教育、家庭平均收入、移民状态、同居状态、就业状态、疗养院居住和市类型得出基于调整概率的分布。基于该分布，我们确定了最佳患者（即概率最高的 10%的患者）和最差患者（即概率最低的 10%的患者）。我们通过测量最佳患者和最差患者之间的结果实现程度的差距来评估护理质量的差异。
主要结果是全有或全无的实现，定义为接受所有相关流程措施。次要结果是个别流程措施的实现，包括术前优化、早期手术、早期活动、疼痛评估、基本活动能力、营养风险和抗骨质疏松药物需求、预防跌倒和出院后康复计划。
对于最佳患者和最差患者，接受高质量护理的患者比例随时间而变化。2007 年最佳患者和最差患者接受所有合格流程措施的百分比差异为 12（95%CI 6 至 18），而 2016 年为 23（95%CI 19 至 28）。在一系列护理流程中，包括疼痛评估、24 小时内活动、评估抗骨质疏松药物和营养风险评估，最佳患者和最差患者之间的差异一直存在。
最佳患者和最差患者之间的护理差异随着时间的推移仍然很大。
