Does achieving the best practice tariff improve outcomes in hip fracture patients? An observational cohort study.
To determine if the introduction of the best practice tariff (BPT) has improved survival of the elderly hip fracture population, or if achieving BPT results in improved survival for an individual.



A single university-affiliated teaching hospital.



2541 patients aged over 60 admitted with a neck of femur fracture between 2008 and 2010 and from 2012 to 2014 were included, to create two cohorts of patients, before and after the introduction of BPT. The post-BPT cohort was divided into two groups, those who achieved the criteria and those who did not.



Primary outcomes of interest were differences in mortality across cohorts. Secondary analysis was performed to identify associations between individual BPT criteria and mortality.



The introduction of BPT did not significantly alter overall 30-mortality in the hip fracture population (8.3% pre-BPT vs 10.0% post-BPT; p=0.128). Neither was there a significant reduction in length of stay (15 days (IQR 9-21) pre-BPT vs 14 days (IQR 11-22); p=0.236). However, the introduction of BPT was associated with a reduction in the time from admission to theatre (median 44 hours pre-BPT (IQR 24-44) vs 23 hours post-BPT (IQR 17-30); p<0.005). 30-day mortality in those who achieved BPT was significantly lower (6.0% vs 21.0% in those who did not achieve-BPT; p<0.005). There was a survival benefit at 1 year for those who achieved BPT (28.6% vs 42.0% did not achieve-BPT; p<0.005). Multivariate logistic regression revealed that of the BPT criteria, AMT monitoring and expedited surgery were the only BPT criteria that significantly influenced survival.



The introduction of the BPT has not led to a demonstrable improvement in outcomes at organisational level, though other factors may have confounded any benefits. However, patients where BPT criteria are met appear to have improved outcomes.
Department of Trauma and Orthopaedics, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
B
B
Oakley
Department of Trauma and Orthopaedics, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
J
J
Nightingale
Department of Trauma and Orthopaedics, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
C G
CG
Moran
Anaesthesia and Critical Care Section, Division of Clinical Neuroscience, Queen's Medical Centre, University of Nottingham, Nottingham, UK.|Department of Anaesthesia, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
I K
IK
Moppett
D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006620:Hip Fractures / Q000401:mortality*; D006784:Hospitals, Teaching; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D006113:United Kingdom
ORTHOPAEDIC & TRAUMA SURGERY