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REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE): protocol for a mixed-methods study

INTRODUCTION: Substantial variation in the delivery of hip fracture care, and patient outcomes persists between hospitals, despite established UK national standards and guidelines. Patients’ outcomes are partly explained by patient-level risk factors, but it is hypothesised that organisational-level...

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Autores principales: Patel, Rita, Drew, Sarah, Johansen, Antony, Chesser, Tim, Javaid, Muhammad K, Griffin, Xavier L, Jones, Tim, Griffin, Jill, Bradshaw, Marianne, Whale, Katie, Barbosa, Estela Capelas, Marques, Elsa M R, Ben-Shlomo, Yoav, Gooberman-Hill, Rachael, Judge, Andrew, Gregson, Celia L
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137248/
https://www.ncbi.nlm.nih.gov/pubmed/34011603
http://dx.doi.org/10.1136/bmjopen-2021-049763
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author Patel, Rita
Drew, Sarah
Johansen, Antony
Chesser, Tim
Javaid, Muhammad K
Griffin, Xavier L
Jones, Tim
Griffin, Jill
Bradshaw, Marianne
Whale, Katie
Barbosa, Estela Capelas
Marques, Elsa M R
Ben-Shlomo, Yoav
Gooberman-Hill, Rachael
Judge, Andrew
Gregson, Celia L
author_facet Patel, Rita
Drew, Sarah
Johansen, Antony
Chesser, Tim
Javaid, Muhammad K
Griffin, Xavier L
Jones, Tim
Griffin, Jill
Bradshaw, Marianne
Whale, Katie
Barbosa, Estela Capelas
Marques, Elsa M R
Ben-Shlomo, Yoav
Gooberman-Hill, Rachael
Judge, Andrew
Gregson, Celia L
author_sort Patel, Rita
collection PubMed
description INTRODUCTION: Substantial variation in the delivery of hip fracture care, and patient outcomes persists between hospitals, despite established UK national standards and guidelines. Patients’ outcomes are partly explained by patient-level risk factors, but it is hypothesised that organisational-level factors account for the persistence of unwarranted variation in outcomes. The mixed-methods REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE) study, aims to determine key organisational factors to target to improve patient care. METHODS AND ANALYSIS: Quantitative analysis will assess the outcomes of patients treated at 172 hospitals in England and Wales (2016–2019) using National Hip Fracture Database data combined with English Hospital Episodes Statistics; Patient Episode Database for Wales; Civil Registration (deaths) and multiple organisational-level audits to characterise each service provider. Statistical analyses will identify which organisational factors explain variation in patient outcomes, and typify care pathways with high-quality consistent patient outcomes. Documentary analysis of 20 anonymised British Orthopaedic Association hospital-initiated peer-review reports, and qualitative interviews with staff from four diverse UK hospitals providing hip fracture care, will identify barriers and facilitators to care delivery. The COVID-19 pandemic has posed a major challenge to the resilience of services and interviews will explore strategies used to adapt and innovate. This system-wide understanding will inform the development, in partnership with key national stakeholders, of an ‘Implementation Toolkit’ to inform and improve commissioning and delivery of hip fracture services. ETHICS AND DISSEMINATION: This study was approved: quantitative study by London, City and East Research Ethics Committee (20/LO/0101); and qualitative study by Faculty of Health Sciences University of Bristol Research Ethics Committee (Ref: 108284), National Health Service (NHS) Health Research Authority (20/HRA/71) and each NHS Trust provided Research and Development approval. Findings will be disseminated through scientific conferences, peer-reviewed journals and online workshops.
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spelling pubmed-81372482021-06-01 REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE): protocol for a mixed-methods study Patel, Rita Drew, Sarah Johansen, Antony Chesser, Tim Javaid, Muhammad K Griffin, Xavier L Jones, Tim Griffin, Jill Bradshaw, Marianne Whale, Katie Barbosa, Estela Capelas Marques, Elsa M R Ben-Shlomo, Yoav Gooberman-Hill, Rachael Judge, Andrew Gregson, Celia L BMJ Open Geriatric Medicine INTRODUCTION: Substantial variation in the delivery of hip fracture care, and patient outcomes persists between hospitals, despite established UK national standards and guidelines. Patients’ outcomes are partly explained by patient-level risk factors, but it is hypothesised that organisational-level factors account for the persistence of unwarranted variation in outcomes. The mixed-methods REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE) study, aims to determine key organisational factors to target to improve patient care. METHODS AND ANALYSIS: Quantitative analysis will assess the outcomes of patients treated at 172 hospitals in England and Wales (2016–2019) using National Hip Fracture Database data combined with English Hospital Episodes Statistics; Patient Episode Database for Wales; Civil Registration (deaths) and multiple organisational-level audits to characterise each service provider. Statistical analyses will identify which organisational factors explain variation in patient outcomes, and typify care pathways with high-quality consistent patient outcomes. Documentary analysis of 20 anonymised British Orthopaedic Association hospital-initiated peer-review reports, and qualitative interviews with staff from four diverse UK hospitals providing hip fracture care, will identify barriers and facilitators to care delivery. The COVID-19 pandemic has posed a major challenge to the resilience of services and interviews will explore strategies used to adapt and innovate. This system-wide understanding will inform the development, in partnership with key national stakeholders, of an ‘Implementation Toolkit’ to inform and improve commissioning and delivery of hip fracture services. ETHICS AND DISSEMINATION: This study was approved: quantitative study by London, City and East Research Ethics Committee (20/LO/0101); and qualitative study by Faculty of Health Sciences University of Bristol Research Ethics Committee (Ref: 108284), National Health Service (NHS) Health Research Authority (20/HRA/71) and each NHS Trust provided Research and Development approval. Findings will be disseminated through scientific conferences, peer-reviewed journals and online workshops. BMJ Publishing Group 2021-05-19 /pmc/articles/PMC8137248/ /pubmed/34011603 http://dx.doi.org/10.1136/bmjopen-2021-049763 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Geriatric Medicine
Patel, Rita
Drew, Sarah
Johansen, Antony
Chesser, Tim
Javaid, Muhammad K
Griffin, Xavier L
Jones, Tim
Griffin, Jill
Bradshaw, Marianne
Whale, Katie
Barbosa, Estela Capelas
Marques, Elsa M R
Ben-Shlomo, Yoav
Gooberman-Hill, Rachael
Judge, Andrew
Gregson, Celia L
REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE): protocol for a mixed-methods study
title REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE): protocol for a mixed-methods study
title_full REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE): protocol for a mixed-methods study
title_fullStr REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE): protocol for a mixed-methods study
title_full_unstemmed REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE): protocol for a mixed-methods study
title_short REducing unwarranted variation in the Delivery of high qUality hip fraCture services in England and Wales (REDUCE): protocol for a mixed-methods study
title_sort reducing unwarranted variation in the delivery of high quality hip fracture services in england and wales (reduce): protocol for a mixed-methods study
topic Geriatric Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137248/
https://www.ncbi.nlm.nih.gov/pubmed/34011603
http://dx.doi.org/10.1136/bmjopen-2021-049763
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