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The Bone & Joint Journal
Vol. 101-B, Issue 10 | Pages 1292 - 1299
1 Oct 2019
Masters J Metcalfe D Parsons NR Achten J Griffin XL Costa ML

Aims

This study explores data quality in operation type and fracture classification recorded as part of a large research study and a national audit with an independent review.

Patients and Methods

At 17 centres, an expert surgeon reviewed a randomly selected subset of cases from their centre with regard to fracture classification using the AO system and type of operation performed. Agreement for these variables was then compared with the data collected during conduct of the World Hip Trauma Evaluation (WHiTE) cohort study. Both types of surgery and fracture classification were collapsed to identify the level of detail of reporting that achieved meaningful agreement. In the National Hip Fracture Database (NHFD), the types of operation and fracture classification were explored to identify the proportion of “highly improbable” combinations.


The Bone & Joint Journal
Vol. 101-B, Issue 8 | Pages 1015 - 1023
1 Aug 2019
Metcalfe D Zogg CK Judge A Perry DC Gabbe B Willett K Costa ML

Aims

Hip fractures are associated with high morbidity, mortality, and costs. One strategy for improving outcomes is to incentivize hospitals to provide better quality of care. We aimed to determine whether a pay-for-performance initiative affected hip fracture outcomes in England by using Scotland, which did not participate in the scheme, as a control.

Materials and Methods

We undertook an interrupted time series study with data from all patients aged more than 60 years with a hip fracture in England (2000 to 2018) using the Hospital Episode Statistics Admitted Patient Care (HES APC) data set linked to national death registrations. Difference-in-differences (DID) analysis incorporating equivalent data from the Scottish Morbidity Record was used to control for secular trends. The outcomes were 30-day and 365-day mortality, 30-day re-admission, time to operation, and acute length of stay.


The Bone & Joint Journal
Vol. 101-B, Issue 6 | Pages 708 - 714
1 Jun 2019
Metcalfe D Costa ML Parsons NR Achten J Masters J Png ME Lamb SE Griffin XL

Aims

This study sought to determine the proportion of older adults with hip fractures captured by a multicentre prospective cohort, the World Hip Trauma Evaluation (WHiTE), whether there was evidence of selection bias during WHiTE recruitment, and the extent to which the WHiTE cohort is representative of the broader population of older adults with hip fractures.

Patients and Methods

The characteristics of patients recruited into the WHiTE cohort study were compared with those treated at WHiTE hospitals during the same timeframe and submitted to the National Hip Fracture Database (NHFD).


The Bone & Joint Journal
Vol. 98-B, Issue 9 | Pages 1253 - 1261
1 Sep 2016
Metcalfe D Perry DC Bouamra O Salim A Woodford M Edwards A Lecky FE Costa ML

Aims

We aimed to determine whether there is evidence of improved patient outcomes in Major Trauma Centres following the regionalisation of trauma care in England.

Patients and Methods

An observational study was undertaken using the Trauma Audit and Research Network (TARN), Hospital Episode Statistics (HES) and national death registrations. The outcome measures were indicators of the quality of trauma care, such as treatment by a senior doctor and clinical outcomes, such as mortality in hospital.


The Bone & Joint Journal
Vol. 98-B, Issue 3 | Pages 414 - 419
1 Mar 2016
Metcalfe D Gabbe BJ Perry DC Harris MB Ekegren CL Zogg CK Salim A Costa ML

Aims

In this study, we aimed to determine whether designation as a major trauma centre (MTC) affects the quality of care for patients with a fracture of the hip.

Patients and Methods

All patients in the United Kingdom National Hip Fracture Database, between April 2010 and December 2013, were included. The indicators of quality that were recorded included the time to arrival on an orthopaedic ward, to review by a geriatrician, and to operation. The clinical outcomes were the development of a pressure sore, discharge home, length of stay, in-hospital mortality, and re-operation within 30 days.