Management of hip fractures in older people in Beijing: a retrospective audit and comparison with evidence-based guidelines and practice in the UK.
Despite the high burden of hip fracture in China, there is limited information on its management. This study investigated the management of hip fractures in a Beijing tertiary hospital and compared practice with that in 180 hospitals in the UK. The findings show a significant gap exists between the countries.


BACKGROUND
The purpose of this study was to determine if the management of older people with hip fractures in a Beijing tertiary hospital is comparable with the UK best practice guidelines for hip fracture management and the UK National Hip Fracture Database 2012, obtained from 180 hospitals.


METHODS
A retrospective audit was undertaken in a large tertiary care hospital in Beijing. Data were compared with the National Hip Fracture Database 2012 collected in 180 hospitals in the UK on the proportion of patients managed according to the UK Blue Book standards.


RESULTS
Sixty-six percent of patients were admitted to an orthopaedic ward within 24 h of fracture, while 100 % of patients in the UK were admitted to an orthopaedic ward within 24 h of arrival to an accident and emergency department. Only 8 % of patients received surgery within 48 h of admission compared with 83 % in the UK; 10 % received no surgery compared with 2.5 % in the UK; and 27 % received orthogeriatrician assessment compared with 70 % in the UK. New pressure ulcers developed in 2 % of patients compared with 3.7 % of those in the UK; whereas, 0.3 % of patients were assessed for osteoporosis treatment and 3.8 % received falls assessment, and comparable figures for the UK were 94 and 92 %, respectively.


CONCLUSIONS
Significant gaps exist in hip fracture management in the Beijing hospital compared with the best practice achieved in 180 UK hospitals, highlighting the need to implement and evaluate proactive strategies to increase the uptake of best practice hip fracture care in China.
The George Institute for Global Health, Peking University Health Science Center, Beijing, China.
M
M
Tian
Jishuitan Hospital, Beijing, China.
X
X
Gong
The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK. santosh.rath@georgeinstitute.ox.ac.uk.|Oxford Martin School, University of Oxford, 34 Broad Street, Oxford, OX1 3BD, UK. santosh.rath@georgeinstitute.ox.ac.uk.
S
S
Rath
Jishuitan Hospital, Beijing, China.
J
J
Wei
The George Institute for Global Health, Peking University Health Science Center, Beijing, China.
L L
LL
Yan
Kadoorie Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, UK.
S E
SE
Lamb
The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.
R I
RI
Lindley
The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.
C
C
Sherrington
Kadoorie Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, UK.
K
K
Willett
The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK.|The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.
R
R
Norton
D000368:Aged; D000369:Aged, 80 and over; D002681:China; D019468:Disease Management; D019317:Evidence-Based Medicine; D005260:Female; D006299:Health Services for the Aged / Q000458:organization & administration* / Q000592:standards; D006620:Hip Fractures / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011364:Professional Practice / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D006113:United Kingdom
Aged care; Audit; China; Hip fracture