title: Are process performance measures associated with clinical outcomes among patients with hip fractures? A population-based cohort study.
abstract: OBJECTIVE
  To examine the association between process performance measures and clinical outcome among patients with hip fracture.
  
  
  METHODS
  Nationwide, population-based follow-up study.
  
  
  METHODS
  Public Danish hospitals.
  
  
  METHODS
  A total of 25 354 patients 65 years or older who were admitted with a hip fracture in Denmark between 2010 and 2013.
  
  
  METHODS
  The process performance measures, including systematic pain assessment, early mobilization, basic mobility assessment at arrival and at discharge, post-discharge rehabilitation program, anti-osteoporotic medication and prevention of future fall accidents measures, were analysed individually as well as an opportunity-based score defined as the proportion of all relevant performance measures fulfilled for the individual patient (0-50%, 50-75% and 75-100%).
  
  
  METHODS
  Thirty-day mortality, 30-day readmission after discharge and length of stay (LOS).
  
  
  RESULTS
  Fulfilling 75-100% of the relevant process performance measures was associated with lower 30-day mortality (22.6% vs. 8.5%, adjusted odds ratio (OR) 0.31 (95% CI: 0.28-0.35)) and lower odds for readmission (21.7% vs. 17.4%, adjusted OR 0.78 (95% CI: 0.70-0.87)). The overall opportunity score for quality of care was not associated with LOS (adjusted OR 1.00 (95% CI: 0.98-1.04)). Mobilization within 24 h postoperatively was the process with the strongest association with lower 30-day mortality, readmission risk and shorter LOS.
  
  
  CONCLUSIONS
  Higher quality of in-hospital care and in particular early mobilization was associated with a better clinical outcome, including lower 30-day mortality, among patients with hip fracture.
authors: Department of Orthopedic Surgery, Horsens Hospital, Sundvej 30, DK-8700 Horsens, Denmark.|Department of Orthopedic Surgery, Aarhus University Hospital, Tage-Hansens Gade, DK-8200 Aarhus N, Denmark.
authors: Pia Kjaer
authors: PK
authors: Kristensen
authors: Department of Orthopedic Surgery, Aarhus University Hospital, Tage-Hansens Gade , DK-8200 Aarhus N, Denmark.
authors: Theis Muncholm
authors: TM
authors: Thillemann
authors: Department of Orthopedic Surgery, Aarhus University Hospital, Tage-Hansens Gade , DK-8200 Aarhus N, Denmark.
authors: Kjeld
authors: K
authors: Søballe
authors: Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200 Aarhus N, Denmark.
authors: Søren Paaske
authors: SP
authors: Johnsen
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark; D004434:Early Ambulation / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000401:mortality / Q000534:rehabilitation / Q000628:therapy*; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010024:Osteoporosis / Q000188:drug therapy; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010147:Pain Measurement / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data