title: Achieving best practice tariff may not reflect improved survival after hip fracture treatment.
abstract: OBJECTIVE
  The best practice tariff (BPT) incentivizes hospitals in the England and Wales National Health Service to provide multiprofessional care to patients with hip fractures. The initial six targets included: 1) admission under consultant-led joint orthopedic-geriatric care, 2) multidisciplinary assessment protocol on admission, 3) surgery within 36 hours, 4) geriatrician review within 72 hours, 5) multiprofessional rehabilitation, and 6) assessment for falls and bone protection. We aimed to examine the relationship between BPT achievement and important patient outcomes and whether the BPT could predict these independently of other validated predictors.
  
  
  METHODS
  A retrospective review was conducted on 516 patient episodes. Four outcomes were defined: 1) 30-day mortality, 2) 365-day mortality, 3) postoperative length of stay on trauma ward (LOS-T), and 4) total post-operative hospital LOS (LOS-H). Patient episodes were grouped as follows: 1) group 1, pre-BPT, 2) group 2, BPT achievers, 3) group 3, BPT fails. These were compared for mortality (χ (2) test) and for LOS (Kruskal-Wallis test). Event analysis was done for groups 2 and 3 using generalized linear modeling, with age, sex, American Society of Anesthesiologists grade, hemoglobin, albumin, creatinine, and BPT achievement evaluated as predictors.
  
  
  RESULTS
  The three groups did not differ significantly in baseline characteristics or outcomes. In the event analysis, the risk of 30-day mortality was related only to abnormal creatinine (P=0.025); mortality at 365 days was related significantly to low albumin (P=0.023) and weakly to abnormal creatinine (P=0.089). The risks of both increased LOS-T and LOS-H were related to age only (P=0.052, P<0.001, respectively).
  
  
  CONCLUSIONS
  Achieving BPT does not predict any outcome of interest on its own.
authors.affiliation: The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK.
authors.forename: Sameer K
authors.initials: SK
authors.lastname: Khan
authors.affiliation: School of Biology, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Mark D F
authors.initials: MD
authors.lastname: Shirley
authors.affiliation: The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Glennie
authors.affiliation: The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK.
authors.forename: Paul V
authors.initials: PV
authors.lastname: Fearon
authors.affiliation: The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Deehan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence / Q000191:economics / Q000706:statistics & numerical data*; D006620:Hip Fractures / Q000401:mortality*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012189:Retrospective Studies; D013222:State Medicine / Q000191:economics / Q000706:statistics & numerical data*; D006113:United Kingdom
keywords: best practice tariff; hip fractures; mortality