title: Quality of care for patients with a fracture of the hip in major trauma centres: a national observational study.
abstract: OBJECTIVE
  In this study, we aimed to determine whether designation as a major trauma centre (MTC) affects the quality of care for patients with a fracture of the hip.
  
  
  METHODS
  All patients in the United Kingdom National Hip Fracture Database, between April 2010 and December 2013, were included. The indicators of quality that were recorded included the time to arrival on an orthopaedic ward, to review by a geriatrician, and to operation. The clinical outcomes were the development of a pressure sore, discharge home, length of stay, in-hospital mortality, and re-operation within 30 days.
  
  
  RESULTS
  There were 289 466 patients, 49 350 (17%) of whom were treated in hospitals that are now MTCs. Using multivariable logistic and generalised linear regression models, there were no significant differences in any of the indicators of the quality of care or clinical outcomes between MTCs, hospitals awaiting MTC designation and non-MTC hospitals.
  
  
  CONCLUSIONS
  These findings suggest that the regionalisation of major trauma in England did not improve or compromise the overall care of elderly patients with a fracture of the hip.
  
  
  CONCLUSIONS
  There is no evidence that reconfiguring major trauma services in England disrupted the treatment of older adults with a fracture of the hip.
authors.affiliation: University of Oxford, Oxford OX3 9DU, UK.
authors.forename: D
authors.initials: D
authors.lastname: Metcalfe
authors.affiliation: Monash University, 99 Commercial Road, Melbourne, Vic 3004, Australia.
authors.forename: B J
authors.initials: BJ
authors.lastname: Gabbe
authors.affiliation: University of Liverpool, Liverpool, L12 2AP, UK.
authors.forename: D C
authors.initials: DC
authors.lastname: Perry
authors.affiliation: Brigham Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Harris
authors.affiliation: Monash University, 99 Commercial Road, Melbourne, Vic 3004, Australia.
authors.forename: C L
authors.initials: CL
authors.lastname: Ekegren
authors.affiliation: Harvard Medical School, One Brigham Circle, Boston, MA 02115, USA.
authors.forename: C K
authors.initials: CK
authors.lastname: Zogg
authors.affiliation: Harvard Medical School, One Brigham Circle, Boston, MA 02115, USA.
authors.forename: A
authors.initials: A
authors.lastname: Salim
authors.affiliation: University of Oxford, Oxford OX3 9DU, UK.
authors.forename: M L
authors.initials: ML
authors.lastname: Costa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000592:standards*; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: Hip fractures; trauma centres; trauma units