Indicator ref.:
HFra20
Key
considerations
for the NICE
Committee
Appraisal of quality of indicator for provisional CCG OIS
Indicator title:
Of people with hip fracture, the proportion who receive a multifactorial risk assessment* of
future falls risk, led by the Hip Fracture programme team evidenced by GMC number of
responsible clinician. *At least medication review, visual acuity, postural BP measurement.
•
The National Hip Fracture Database (NHFD) has been identified as a source for this
indicator. Around 95% of the cases occurring annually are now documented by
NHFD. For the period 1st April 2011 to 31st March 2012 the number of hip
fractures recorded in the NHFD is 60,353. 47,558 (78.8%) of cases meet the
indicator numerator criteria.
•
38% of CCGs are assessing over 95% of patients with hip fracture.
•
There is a similar measure being implemented for the Best Practice Tariff which
does not include specific physical assessments (see What is Measured). It would
be worth considering alignment to that measure as the data will become routinely
collected.
•
In summary: the HSCIC view is that this indicator is feasible.
Rationale
This indicator is based on the NICE Quality Standard for Hip Fracture in adults, statement
11: ‘People with hip fracture are offered a multifactorial risk assessment to identify and
address future falls risk, and are offered individualised intervention if appropriate.’
Suitability of
indicator for
purpose
Data Quality dimensions:
Completeness
Since 2007, NHFD coverage has expanded steadily, with all 188 eligible hospitals in
England, now registered to participate in this optional audit. (‘Eligible’ indicates that they
provide a comprehensive hip fracture service for a local population)
Accuracy
97% of the eligible hospitals regularly upload case records in a standard dataset format that
covers casemix, care and outcomes. Hospitals receive benchmarked feedback that enables
clinicians and managers to monitor and improve the care they provide.
Timeliness
The underlying data required for the construction of the indicator are available on an annual
basis.
Accessibility
The underlying data are held by the National Hip Fracture Database and published in the
annual audit report.
Relevance
This could be used by CCGs to assess the level of service that they commission as it
contributes to the quality of outcome for the patient.
What is
measured
Version 1
Source of data
National Hip Fracture Database
Denominator
The number of patients in the National Hip Fracture Database
Numerator
Of the denominator, the number who have received a multifactorial risk assessment from
the Hip Fracture programme team
Feedback from the NHFD team noted that there is a similar measure being implemented for
the Best Practice Tariff which does not include specific physical assessments. HSCIC
suggest that it would be worth considering alignment to that measure as the data will
become routinely collected.
The standard for the Best Practice Tariff is: ‘A systematic assessment by a suitably trained
person e.g. Geriatrician or a specialist assessment trained nurse which must cover the
following domains:- Falls history (noting previous falls), cause of index fall (including
medication review), risk factors for falling and injury (including fracture) and from this
information formulate and document a plan of action to prevent further falls.’
There is no requirement for specific physical assessments.
How data are
aggregated
This indicator will be a percentage
Risk
adjustment
This indicator would not be adjusted or standardised
Scientific
validity
There may be local variation in data quality, particularly diagnostic and procedure coding.
Interpretation
A high percentage is desirable. Quality Statement 11 in the NICE Quality Standard for Hip
Fracture in Adults recommends that patients are assessed “to identify their risk of falling in
the future, and are offered help tailored to their circumstances to reduce these risks if
needed.”
Equality
assessment
The following fields are available in NHFD which would support analysis by the following
equality dimensions: Age and Gender. However small volumes of patients in some CCGs
would mean that analysis below CCG level would have to be suppressed (numbers of 5 or
less are not published to ensure that individuals cannot be identified).
Use, follow-up
investigation
and action
The data could be analysed by the equality dimensions to investigate if there are specific
issues within certain groups. HSCIC will assess the options for this analysis as part of
further development and checking for data quality issues. Publication of the indicator
broken down by the equality dimensions may be restricted due to suppression, but CCGs
could also undertake local analysis.
Feedback
from HSCIC
consultation
No consultees completed the survey on this item although one person made the following
comment:
Do you have any other views or general feedback that you would like to provide about this
indicator?
Where are all these hip fracture programme teams? But that is kind of what you are getting
at.
Version 1
Sample data – The sample data is for the full-year 2011/12
CCG CCG1 CCG2 CCG3 CCG4 CCG5 CCG6 CCG7 CCG8 CCG9 CCG10 Denominator 59 175 212 238 239 109 224 647 294 128 Numerator 1 8 10 12 14 9 22 67 34 20 % 1.7% 4.6% 4.7% 5.0% 5.9% 8.3% 9.8% 10.4% 11.6% 15.6% CCG CCG202 CCG203 CCG204 CCG205 CCG206 CCG207 CCG208 CCG209 CCG210 CCG211 Denominator 208 107 223 247 138 734 166 266 82 88 38% (81 CCGs) are assessing 95% or more of their hip fracture patients.
Version 1
Numerator 206 106 221 245 137 729 165 265 82 88 % 99.0% 99.1% 99.1% 99.2% 99.3% 99.3% 99.4% 99.6% 100.0% 100.0%