The fractures of the hip are a main problem of health care. These fractures will be multiply by 2 in 2025 and 3 in 2050. In the population of old people, 1/3 of the women and 1/9 of the men will have a fracture of their hip. Some authors used the name of “EPIDEMIC”. The aima of the INPECH project (Indicators of the Performance for the comparison between hospital) was to check if the comparison of performances of clinical teams, on the basis of indicators chosen by themselves, allowed to improve their performances. It was an experimentation of a volonteer processes of comparison of performance between 3 multidisciplinary teams. The study followed some stages:
in every hospital, description of the process of care of the hip fractures with a choice of indicators of performance (difficulties of the care percepted by the professionals, possibilities of improvement, feasibility of the record of the indicators during the whole process) a first meeting of concertation with the three hospitals where a common choice of 20 indicators was done: 5 factors of adjustement corresponding to the prefracture status, 10 factors of the processes and 5 factors recorded at 3 months postoperatively a first period of inclusion (433 patients of more than 65 years-old) a second meeting of confrontation in order to analyze the results of the first inclusion period and to have exchange between the different teams about the disparities - the age, the autonomy and the mobility of the patients did not differ between the hospitals - the preoperative time was significantly different: 0.7 to 3.6 days - the time of the first get up (2 to 4 days), of the first social demand 3 to 7 days), of the hospitalization in surgery (9 to 14 days) and the rate of transfert in rehabilitation centers varied significantly between the centers. - At three months, the mortality, the levels of dependance and of autonomy were not significantly different. Each team had a reflexion about the opportunities of improvement and the actions to begin A second period of inclusion was realized in order to objectivize if the proposed improvements allowed a real change of our professional practices. (423 patients) The analysis of this second inclusion authorized a real change in our professional practices and showed the efficacy of the indicators which were improved. This study had permitted to show qualitative differences of care of hip fractures between the hospitals. The confrontation between the teams had authorized a positive reflexion of some of our professional practices and the improvement was underlined by the second series of inclusion.
