Does achieving the best practice tariff improve outcomes in hip fracture patients? An observational cohort study
Objectives: To determine if the introduction of the best practice tariff (BPT) has improved survival of the elderly hip fracture population, or if achieving BPT results in improved survival for an individual. Setting: A single university-affiliated teaching hospital. Participants: 2,541 patients a...
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| Format: | Article |
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BMJ Publishing Group
2017
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| Online Access: | https://eprints.nottingham.ac.uk/39829/ |
| _version_ | 1848795922610257920 |
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| author | Oakley, Ben Nightingale, Jessica Moran, Christopher G. Moppett, Iain K. |
| author_facet | Oakley, Ben Nightingale, Jessica Moran, Christopher G. Moppett, Iain K. |
| author_sort | Oakley, Ben |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Objectives: To determine if the introduction of the best practice tariff (BPT) has improved survival of the elderly hip fracture population, or if achieving BPT results in improved survival for an individual.
Setting: A single university-affiliated teaching hospital.
Participants: 2,541 patients aged over 60 admitted with a neck of femur fracture between 2008 and 2010 and from 2012 to 2014 were included, to create two cohorts of patients, before and after the introduction of BPT. The post-BPT cohort was divided into two groups, those who achieved the criteria and those who did not.
Primary and Secondary Outcome Measures: Primary outcomes of interest were differences in mortality across cohorts. Secondary analysis was performed to identify associations between individual BPT criteria and mortality.
Results: The introduction of BPT did not significantly alter overall 30-mortality in the hip fracture population (8.3% pre-BPT vs 10.0% post-BPT; p = 0.128). Neither was there a significant reduction in length of stay (15 days (IQR 9-21) pre-BPT vs 14 days (IQR 11-22); p=0.236). However, the introduction of BPT was associated with a reduction in the time from admission to theatre (median 44hours pre-BPT (IQR 24-44) vs 23hours post-BPT (IQR 17-30); p<0.005). 30-day mortality in those who achieved BPT was significantly lower (6.0% vs 21.0% in those who did not achieve-BPT; p < 0.005). There was a survival benefit at one year for those who achieved BPT (28.6% vs 42.0% did not achieve-BPT; p<0.005). Multivariate logistic regression revealed that of the BPT criteria, AMT monitoring and expedited surgery were the only BPT criteria that significantly influenced survival.
Conclusion: The introduction of the BPT has not led to a demonstrable improvement in outcomes at organisational level, though other factors may have confounded any benefits. However, patients where BPT criteria are met appear to have improved outcomes. |
| first_indexed | 2025-11-14T19:39:47Z |
| format | Article |
| id | nottingham-39829 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:39:47Z |
| publishDate | 2017 |
| publisher | BMJ Publishing Group |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-398292024-08-15T15:21:22Z https://eprints.nottingham.ac.uk/39829/ Does achieving the best practice tariff improve outcomes in hip fracture patients? An observational cohort study Oakley, Ben Nightingale, Jessica Moran, Christopher G. Moppett, Iain K. Objectives: To determine if the introduction of the best practice tariff (BPT) has improved survival of the elderly hip fracture population, or if achieving BPT results in improved survival for an individual. Setting: A single university-affiliated teaching hospital. Participants: 2,541 patients aged over 60 admitted with a neck of femur fracture between 2008 and 2010 and from 2012 to 2014 were included, to create two cohorts of patients, before and after the introduction of BPT. The post-BPT cohort was divided into two groups, those who achieved the criteria and those who did not. Primary and Secondary Outcome Measures: Primary outcomes of interest were differences in mortality across cohorts. Secondary analysis was performed to identify associations between individual BPT criteria and mortality. Results: The introduction of BPT did not significantly alter overall 30-mortality in the hip fracture population (8.3% pre-BPT vs 10.0% post-BPT; p = 0.128). Neither was there a significant reduction in length of stay (15 days (IQR 9-21) pre-BPT vs 14 days (IQR 11-22); p=0.236). However, the introduction of BPT was associated with a reduction in the time from admission to theatre (median 44hours pre-BPT (IQR 24-44) vs 23hours post-BPT (IQR 17-30); p<0.005). 30-day mortality in those who achieved BPT was significantly lower (6.0% vs 21.0% in those who did not achieve-BPT; p < 0.005). There was a survival benefit at one year for those who achieved BPT (28.6% vs 42.0% did not achieve-BPT; p<0.005). Multivariate logistic regression revealed that of the BPT criteria, AMT monitoring and expedited surgery were the only BPT criteria that significantly influenced survival. Conclusion: The introduction of the BPT has not led to a demonstrable improvement in outcomes at organisational level, though other factors may have confounded any benefits. However, patients where BPT criteria are met appear to have improved outcomes. BMJ Publishing Group 2017-02-01 Article PeerReviewed Oakley, Ben, Nightingale, Jessica, Moran, Christopher G. and Moppett, Iain K. (2017) Does achieving the best practice tariff improve outcomes in hip fracture patients? An observational cohort study. BMJ Open, 7 (2). pp. 1-8. ISSN 2044-6055 Hip fracture Trauma Elderly best practice tariff http://bmjopen.bmj.com/content/7/2/e014190 doi:10.1136/bmjopen-2016-014190 doi:10.1136/bmjopen-2016-014190 |
| spellingShingle | Hip fracture Trauma Elderly best practice tariff Oakley, Ben Nightingale, Jessica Moran, Christopher G. Moppett, Iain K. Does achieving the best practice tariff improve outcomes in hip fracture patients? An observational cohort study |
| title | Does achieving the best practice tariff improve outcomes in hip fracture patients? An observational cohort study |
| title_full | Does achieving the best practice tariff improve outcomes in hip fracture patients? An observational cohort study |
| title_fullStr | Does achieving the best practice tariff improve outcomes in hip fracture patients? An observational cohort study |
| title_full_unstemmed | Does achieving the best practice tariff improve outcomes in hip fracture patients? An observational cohort study |
| title_short | Does achieving the best practice tariff improve outcomes in hip fracture patients? An observational cohort study |
| title_sort | does achieving the best practice tariff improve outcomes in hip fracture patients? an observational cohort study |
| topic | Hip fracture Trauma Elderly best practice tariff |
| url | https://eprints.nottingham.ac.uk/39829/ https://eprints.nottingham.ac.uk/39829/ https://eprints.nottingham.ac.uk/39829/ |