The Dutch Hip Fracture Audit: evaluation of the quality of multidisciplinary hip fracture care in the Netherlands
The Dutch Hip Fracture Audit: evaluation of the quality of multidisciplinary hip fracture care in the Netherlands
复制标题
DOI：
10.1007/s11657-019-0576-3
复制
发表时间：
2019-03-01
影响因子：
3
通讯作者：
Voeten, S. C.
中科院分区：
文献类型：
--
作者：
Voeten, Stijn C.;Arends, Arend J.;Voeten, S. C.
全国性的荷兰髋部骨折审计（DHFA）的发起是为了提高髋部骨折护理的质量，通过提供洞察髋部骨折护理的实际质量在日常实践中。基线结果表明在实践中的差异，提供潜在的起点，以提高质量的care.PurposeThe本研究的目的是描述的发展和启动的DHFA。第二个目的是描述髋部骨折护理在荷兰开始的审计，并评估是否有差异，在基线hospital.MethodsEighty-one医院的过程中被要求登记他们的连续髋部骨折患者自2016年4月。2017年是第一个完整的日历年，在审计层面确定了案件确定。三个质量指标被用来描述和评估审计和医院层面的护理过程：在出院时完成的变量的比例，并在3个月后operation，时间手术和orthogeriatric management.ResultsSixty（74%）医院记录14,274例患者在DHFA到2017年12月。2017年，病例确定率为58%，完成变量的平均比例为77%：出院时为91%，3个月时为30%。美国麻醉医师协会评分（阿萨）1-2的患者的中位手术时间为18 h（IQR 7-23），阿萨3-4的患者为21 h（IQR 13-27）。在70岁及以上的患者中，78%接受了正老年病治疗。在医院一级，所有三个指标都表现出显着的实践variance.ConclusionNot所有的医院参加DHFA，数据收集过程需要进一步优化。然而，基线结果表明，在荷兰的医院之间的髋部骨折的做法有明显的差异，提供了潜在的起点，以提高髋部骨折的护理质量。
The nationwide Dutch Hip Fracture Audit (DHFA) is initiated to improve the quality of hip fracture care by providing insight into the actual quality of hip fracture care in daily practice. The baseline results demonstrate variance in practice, providing potential starting points to improve the quality of care.PurposeThe aim of this study is to describe the development and initiation of the DHFA. The secondary aim is to describe the hip fracture care in the Netherlands at the start of the audit and to assess whether there are differences in processes at baseline between hospitals.MethodsEighty-one hospitals were asked to register their consecutive hip fracture patients since April 2016. In 2017, the first full calendar year, the case ascertainment was determined at audit level. Three quality indicators were used to describe and assess the care process at audit and hospital level: the proportion of completed variables at discharge and at 3months after operation, time to surgery and orthogeriatric management.ResultsSixty (74%) hospitals documented 14,274 patients in the DHFA by December 2017. In 2017, the case ascertainment was 58% and the average proportion of completed variables was 77%: 91% at discharge and 30% at 3months. The median time to operation was 18h (IQR 7-23) for American Society of Anesthesiologists score(ASA) 1-2 patients and 21h (IQR 13-27) for ASA 3-4 patients. Of patients aged 70years and older, 78% received orthogeriatric management. At hospital level, all three indicators showed significant practice variance.ConclusionNot all hospitals participate in the DHFA, and the data gathering process needs to be further optimized. However, the baseline results demonstrate an apparent variance in hip fracture practice between hospitals in the Netherlands, providing potential starting points to improve the quality of hip fracture care.