Quality indicators of hip fracture management. A systematic review

Abstract

Objective: To identify standards and quality indicators of hip fracture management from the medical literature.
Methods: We conducted a "systematic review" on the topic of quality indicators of hip fracture management using PubMed database, during 15 years from 2001 to 2015. The collected publications were studied by two readers to extract the different quality indicators of hip fracture management. These indicators were stratified according to their type (process or outcome) and to the time of health care (pre, per or post-operative).
Results: A total of 41 articles were included in the study: The analysis of these articles highlighted a predominance of Anglo-Saxon papers, an increasing rate of publication over time, a dominance of evaluative studies and a multiplicity of guidelines. A total of 46 quality indicators were identified through these articles. Two third were classified as procedural items and 60% were about post-operative hip fracture management. The most assessed indicators and standards, among those related to the preoperative care, were time to surgery (34%) and patient clinical condition assessment (11%). During the operation time, the most assessed indicator was the proportion of patients who have had spinal anesthesia (73%). For the postoperative care, the most common  indicators and standards were length of hospital stay (12%), osteoporosis treatment prescription (8%), mattresses use to prevent pressure ulcer (7%), pressure sores occurring (7%) and in hospital mortality (7%).
Conclusion: This systematic review allowed to identify the main indicators recommended to evaluate the management of hip fracture. The continuous monitoring of these indicators should be generalized in maghrebian countries using strategic dashboards in all hospitals and clinics treating this pathology.