Evidence map›Paper›PMID 38409524›Full record

ArticleCanadian journal of anaesthesia = Journal canadien d'anesthesie2024

A quasi-experimental evaluation of the association between implementation of Quality-Based Procedures funding for hip fractures and improvements in processes and outcomes for hip fracture patients in Ontario: an interrupted time series analysis.

Hui Yu Zhang, Reva R Ramlogan, Robert Talarico, George Grammatopoulos, Steven Papp, Daniel I McIsaac

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Article in Canadian journal of anaesthesia = Journal canadien d'anesthesie, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 2 papers.

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0cells of the map it votes in
2citing papers in PubMed
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1 · What the graph read from it

What it found

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2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Observational
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

Hui Yu ZhangDepartment of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.
Reva R RamloganDepartment of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.
Robert TalaricoInstitute for Clinical Evaluative Sciences (ICES), Ottawa Hospital Research Institute, Ottawa, ON, Canada.
George GrammatopoulosDivision of Orthopedic Surgery, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.
Steven PappDivision of Orthopedic Surgery, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.
Daniel I McIsaacDepartment of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada. dmcisaac@toh.ca.ORCID http://orcid.org/0000-0002-8543-1859

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeIn 2013, Ontario introduced a patient-based funding model for hip fracture care (Quality-Based Procedures [QBP]). The association of QBP implementation with changes in processes and outcomes has not been evaluated.

methodsWe conducted a quasi-experimental study using linked health data for adult hip fractures as an interrupted time series. The pre-QBP period was from 2008 to 2012 and the post-QBP period was from 2014 to 2018; 2013 was excluded as a wash-in period. We used segmented regression analyses to estimate the association of QBP implementation with changes in processes (surgery in less than two days from admission, use of echocardiography, use of nerve blocks, and provision of geriatric care) and clinical outcomes (90-day mortality, 90-day readmissions, length of stay, and days alive at home). We estimated the immediate (level) change, trend (slope) postimplementation, and total counterfactual differences. Sensitivity analyses included case-mix adjustment and stratification by hospital type and procedure.

resultsWe identified 45,500 patients in the pre-QBP period and 41,256 patients in the post-QBP period. There was a significant total counterfactual increase in the use of nerve blocks (11.1%; 95% confidence interval [CI], 6.2 to 16.0) and a decrease in the use of echocardiography (-2.5%; 95% CI, -3.7 to -1.3) after QBP implementation. The implementation of QBP was not associated with a clinically or statistically meaningful change in 90-day mortality, 90-day readmission, length of stay, or number of days alive at home.

conclusionEvaluation of the QBP program is crucial to inform ongoing and future changes to policy and funding for hip fracture care. The introduction of the QBP Hip Fracture program, supported by evidence-based recommendations, was associated with improved application of some evidence-based processes of care but no changes in clinical outcomes. There is a need for ongoing development and evaluation of funding models to identify optimal strategies to improve the value and outcomes of hip fracture care. STUDY REGISTRATION: Open Science Framework ( https://osf.io/2938h/ ); first posted 13 June 2022.

Indexed as

Hip FracturesInterrupted Time Series AnalysisPatient ReadmissionAgedAged, 80 and overFemaleHumansLength of StayMaleOntarioQuality Improvementhealth policyhip fracturequality improvementquasi-experimental design

Identifiers

PMID38409524

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.