title: Increased orthogeriatrician involvement in hip fracture care and its impact on mortality in England.
abstract: to describe the increase in orthogeriatrician involvement in hip fracture care in England and its association with improvements in time to surgery and mortality.
  
  
  
  analysis of Hospital Episode Statistics for 196,401 patients presenting with hip fracture to 150 hospitals in England between 1 April 2010 and 28 February 2014, combined with data on orthogeriatrician hours from a national organisational survey.
  
  
  
  we examined changes in the average number of hours worked by orthogeriatricians in orthopaedic departments per patient with hip fracture, and their potential effect on mortality within 30 days of presentation. The role of prompt surgery (on day of or day after presentation) was explored as a potential confounding factor. Associations were assessed using conditional Poisson regression models with adjustment for patients' sex, age and comorbidity and year, with hospitals treated as fixed effects.
  
  
  
  between 2010 and 2013, there was an increase of 2.5 hours per patient in the median number of hours worked by orthogeriatricians-from 1.5 to 4.0 hours. An increase of 2.5 hours per patient was associated with a relative reduction in mortality of 3.4% (95% confidence interval 0.9% to 5.9%, P = 0.01). This corresponds to an absolute reduction of approximately 0.3%. Higher numbers of orthogeriatrician hours were associated with higher rates of prompt surgery, but were independently associated with lower mortality.
  
  
  
  in the context of initiatives to improve hip fracture care, we identified statistically significant and robust associations between increased orthogeriatrician hours per patient and reduced 30-day mortality.
authors.affiliation: Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.|Clinical Effectiveness Unit, The Royal College of Surgeons of England, 34-43 Lincoln's Inn Fields, London WC2A 3PE, UK.|Nuffield Trust-Research, London W1G 7LP, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Neuburger
authors.affiliation: Formerly of Geriatric Medicine Unit, School of Clinical Sciences and Community Health, College of Medicine and Veterinary Medicine, Edinburgh University, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Currie
authors.affiliation: Basildon & Thurrock University Hospitals NHS Foundation Trust, Nethermayne, Basildon, Essex, SS16 5NL, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Wakeman
authors.affiliation: Trauma Unit, Cardiff and Vale NHS Trust, Cardiff CF14 4XW, UK.
authors.forename: Antony
authors.initials: A
authors.lastname: Johansen
authors.affiliation: Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.|Clinical Effectiveness Unit, The Royal College of Surgeons of England, 34-43 Lincoln's Inn Fields, London WC2A 3PE, UK.
authors.forename: Carmen
authors.initials: C
authors.lastname: Tsang
authors.affiliation: Springcare Ltd., Beech House, Wollerton, Shropshire TF9 3NB, UK.
authors.forename: Fay
authors.initials: F
authors.lastname: Plant
authors.affiliation: Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Wilson
authors.affiliation: Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.|Clinical Effectiveness Unit, The Royal College of Surgeons of England, 34-43 Lincoln's Inn Fields, London WC2A 3PE, UK.
authors.forename: David A
authors.initials: DA
authors.lastname: Cromwell
authors.affiliation: Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
authors.forename: Jan
authors.initials: J
authors.lastname: van der Meulen
authors.affiliation: Department of Medical Statistics, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors.forename: Bianca
authors.initials: B
authors.lastname: De Stavola
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004739:England / Q000453:epidemiology; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000401:mortality* / Q000639:trends*; D000072219:Geriatricians / Q000639:trends*; D006620:Hip Fractures / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072161:Orthopedic Surgeons / Q000639:trends*; D010348:Patient Care Team / Q000639:trends; D010561:Personnel Staffing and Scheduling / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000639:trends*; D058996:Quality Improvement / Q000639:trends; D019984:Quality Indicators, Health Care / Q000639:trends; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment / Q000639:trends; D016896:Treatment Outcome
keywords: hip fracture; mortality; older people; orthogeriatrics