Use of best practice tariffs may improve quality of life among patients with hip fracture
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Research from the National Health Service showed attainment of best practice tariffs may improve health-related quality of life among patients who experienced a hip fracture.
Matthew L. Costa and colleagues fitted regression models to each of the best practice tariff indicators and overall attainment among 6,532 patients 60 years old and older treated operatively for a hip fracture across 20 acute U.K. National Health Service hospitals. Researchers assessed the impact of attainment on health-related quality of life by quantifying improvement in EuroQol-5D five-level questionnaire from estimated regression model coefficients.
Overall, 1,060 participants died by follow-up, according to researchers. Results showed 57% of participants achieved best practice, with no differences in age, cognitive ability and mobility at baseline for the overall attainment and non-attainment groups. Researchers found “surgery within 36 hours from arrival in the ED” had the poorest attainment of the best practice tariff indicators of 79.2%, while “admitted using an agreed multidisciplinary team protocol” and “postoperative geriatrician-direct multidisciplinary team rehabilitation” were almost universally attained. Researchers noted a statistically significant and small to moderate clinical improvement in EQ-5D at 4 months after injury with the attainment of at least “joint care by surgeon and orthogeriatrician,” “assessment of falls risk and bone health” and “preoperative and postoperative cognitive assessments” best practice tariff indicators.
“The U.K. National Health Service has set seven quality standards for the delivery of care to patients with hip fracture. By delivering care which meets these standards it was hoped that patients would have better outcomes, but evidence that this was the case was limited,” Costa, professor of orthopedic trauma surgery in the Nuffield Department of Orthopedics and Rheumatology and Musculoskeletal Sciences at the University of Oxford, told Healio Orthopedics. “This study from the [World Hip Trauma Evaluation] WHiTE project is the first to show that tariff payments linked to the delivery of recommendations for best care led to better quality of life for patients. Trauma and orthopedic units which can meet all seven standards of care will provide the best outcomes for patients with this serious injury.”
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Many health care systems have gone to “pay-for-performance” measures to enhance quality and reduce costs. These programs have been driven by government payers. In the U.K., the National Health System has instituted a “tariff” program and in the U.S., the Comprehensive Care for Joint Replacement has introduced a “bundled payments” program. Both of which have a similar goal, to incentivize providers and hospitals to provide greater quality and lower cost health care. Numerous reports have reported on the success of these types of programs both in the U.K. and U.S. with regard to decreasing hospitalizations, improving discharge locations and controlling implant costs.
What Matthew L. Costa and colleagues have done is demonstrate an association between this type of program and patient-reported outcomes. While all health care providers seek ways to treat their patients with the greatest quality standards, this paper reports an actual improvement in EQ-5D scores at 4 months post-injury. Not only do the hospitals do better financially, the systems save money, but the patients do better. Longer-term follow-up is needed on patients like these to see if these effects carry through 1 year and beyond. Finally, these data demonstrate that implementing gain-sharing quality programs should not be relegated to elective interventions, as fracture patients can benefit from these measures as well.
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