title: Hip fractures in Finland--a comparison of patient characteristics and outcomes in six hospitals.
abstract: OBJECTIVE
  To compare six Finnish hospitals for the quality of treatment of hip fractures and to obtain information for the development of care.
  
  
  METHODS
  Data of 1179 consecutive hip fracture patients (about 200 patients per hospital) was collected prospectively, using similar standardized forms and focusing on background factors and the four-month functional outcome.
  
  
  RESULTS
  There were significant differences between the hospitals in patient characteristics (age, place of residence, walking ability, use of walking aids, morbidity and type of fracture) and in the unadjusted outcome variables at four months' follow-up (place of residence, mobility, use of walking aids and pain in injured hip). After adjustment for baseline characteristics, there was a significant difference in the post-fracture walking ability between the centres but no significant differences in post-fracture place of residence. Unadjusted mortality did not vary between the centres, but adjustment resulted in significant differences. The most marked difference in surgical methods between the hospitals was seen in the use of either sliding hip screw or Gamma Nail for trochanteric fractures, but this difference was not reflected in the results of multivariate analysis.
  
  
  CONCLUSIONS
  We found minor differences in mobility and mortality between the participating hospitals, and these might serve them as a stimulus for improving their standard of good practice. Continuous quality improvement by repeating the audit cycle is recommended in order to reach and then improve the prevalent standards in the care of hip fracture patients. Confounding factors should be adjusted when comparing the medical centres treating hip fractures, and the evaluation of the results should be multidimensional.
authors.affiliation: Oulu University Hospital, Department of Orthopedic and Trauma Surgery, Oulu, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Heikkinen
authors.forename: R
authors.initials: R
authors.lastname: Willig
authors.forename: A
authors.initials: A
authors.lastname: Hänninen
authors.forename: K
authors.initials: K
authors.lastname: Koskinen
authors.forename: P
authors.initials: P
authors.lastname: Mannismäki
authors.forename: A
authors.initials: A
authors.lastname: Alavaikko
authors.forename: M
authors.initials: M
authors.lastname: von und zu Fraunberg
authors.forename: P
authors.initials: P
authors.lastname: Jalovaara
mesh_terms: D001178:Arthroplasty; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005387:Finland; D005593:Fracture Fixation, Internal; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D011787:Quality of Health Care; D012086:Reoperation; D016896:Treatment Outcome