Department of Trauma Surgery, Leiden University Medical Center, 2333 AA, Leiden, The Netherlands.
Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, The Netherlands.
Eur J Trauma Emerg Surg. 2022 Dec;48(6):4783-4796. doi: 10.1007/s00068-022-02012-y. Epub 2022 Jun 13.
The Dutch Hip Fracture Audit (DHFA), a nationwide hip fracture registry in the Netherlands, registers hip fracture patients and aims to improve quality of care since 2016. This study shows trends in the data quality during the first 5 years of data acquisition within the DHFA, as well as trends over time for designated quality indicators (QI).
All patients registered in the DHFA between 1-1-2016 and 31-12-2020 were included. Data quality-registry case coverage and data completeness-and baseline characteristics are reported. Five QI are analysed: Time to surgery < 48 h, assessment for osteoporosis, orthogeriatric co-management, registration of functional outcomes at three months, 30-day mortality. The independent association between QI results and report year was tested using mixed-effects logistic models and in the case of 30-day mortality adjusted for casemix.
In 2020, the case capture of the DHFA comprised 85% of the Dutch hip fracture patients, 66/68 hospitals participated. The average of missing clinical values was 7.5% in 2016 and 3.2% in 2020. The 3 months follow-up completeness was 36.2% (2016) and 46.8% (2020). The QI 'time to surgery' was consistently high, assessment for osteoporosis remained low, orthogeriatric co-management scores increased without significance, registration of functional outcomes improved significantly and 30-day mortality rates remained unchanged.
The DHFA has successfully been implemented in the past five years. Trends show improvement on data quality. Analysis of several QI indicate points of attention. Future perspectives include lowering the burden of registration, whilst improving (registration of) hip fracture patients outcomes.
荷兰髋关节骨折审核（DHFA）是荷兰全国性的髋关节骨折登记处，自 2016 年以来，该登记处一直致力于提高护理质量。本研究显示了在 DHFA 数据采集的前 5 年内数据质量的趋势，以及随着时间的推移，指定的质量指标（QI）的趋势。
纳入 2016 年 1 月 1 日至 2020 年 12 月 31 日期间在 DHFA 登记的所有患者。报告数据质量-登记病例覆盖率和数据完整性-以及基线特征。分析了 5 个 QI：手术时间<48 小时、骨质疏松评估、骨科老年病共管、三个月时功能结局的登记、30 天死亡率。使用混合效应逻辑模型测试 QI 结果与报告年份之间的独立关联，在 30 天死亡率的情况下，根据病例组合进行调整。
2020 年，DHFA 的病例捕获率占荷兰髋关节骨折患者的 85%，66/68 家医院参与其中。2016 年平均缺失临床值为 7.5%，2020 年为 3.2%。3 个月随访的完整性为 36.2%（2016 年）和 46.8%（2020 年）。QI“手术时间”一直很高，骨质疏松评估仍然较低，骨科老年病共管评分有所提高但无显著意义，功能结局的登记情况显著改善，30 天死亡率保持不变。
DHFA 在过去五年中已成功实施。趋势显示数据质量有所提高。对几个 QI 的分析表明了需要注意的地方。未来的展望包括降低登记负担，同时改善（髋关节骨折患者）结局。
