Indicators - Hip Fracture Clinical Care Standard
Indicators have been developed to support monitoring of the care recommended in the Hip Fracture Clinical Care Standard. Clinicians and healthcare services can use the indicators to support local quality improvement activities.
Indicator specifications
Measurement is a key component of quality improvement processes. The Commission has developed a set of indicators to support clinicians and healthcare services to monitor how well they are implementing the care recommended in this clinical care standard. The indicators are intended to support local quality improvement activities. No benchmarks are set for these indicators by the Commission. However, facilities can compare their performance on each quality indicator to the performance of other facilities, and to the national average in published ANZHFR annual reports and real-time dashboards. A minimum data set was created for the ANZHFR Steering Group, which is outlined in the ANZHFR Data Dictionary.
The definitions required to collect and calculate indicator data are specified in the Metadata Online Registry (METEOR): https://meteor.aihw.gov.au/content/780812
METEOR is an Australian web-based repository of nationally endorsed data and indicator definitions, hosted by the Australian Institute of Health and Welfare (AIHW).
Indicators for local monitoring
Each indicator is described below and links to individual specifications are provided.
Measuring and monitoring patient experiences
Systematic, routine monitoring of patients’ experiences of, and outcomes from, health care is an important way to ensure that the patient’s perspective drives service improvements and person-centred care. This is the case in all health services.
Patient experience measures
While this clinical care standard does not include indicators specific to measuring patient experiences, the Commission strongly encourages healthcare services to use the Australian Hospital Patient Experience Question Set (AHPEQS). AHPEQS is a 12-question generic patient experience survey that has been validated in both day-only and admitted hospital patients across many clinical settings. The instrument is available for download to both private and public sector healthcare services.
Patient-reported outcome measures
In Australia, patient-reported outcome measures (PROMs) are an emerging method of assessing the quality of health care. The Commission is leading a national work program to support the consistent and routine use of PROMs to drive quality improvement.
PROMs are standardised, validated questionnaires that patients complete, without any input from healthcare providers. They are often administered at least twice to an individual patient – at baseline and again after an intervention, or at regular intervals during a chronic illness. The information contributed by patients filling out PROMs questionnaires can be used to support and monitor the movement of health systems towards person-centred, value-based health care.
PROMs are being used to evaluate healthcare effectiveness at different levels of the health system, from the individual level to service and system levels. There is growing interest across Australia and internationally in the routine interrogation of patient-reported outcome information for evaluation and decision-making activities at levels of the health system beyond the clinical consultation.
Patient experience measures
While this clinical care standard does not include indicators specific to measuring patient experiences, the Commission strongly encourages healthcare services to use the Australian Hospital Patient Experience Question Set (AHPEQS). AHPEQS is a 12-question generic patient experience survey that has been validated in both day-only and admitted hospital patients across many clinical settings. The instrument is available for download to both private and public sector healthcare services.
Patient-reported outcome measures
In Australia, patient-reported outcome measures (PROMs) are an emerging method of assessing the quality of health care. The Commission is leading a national work program to support the consistent and routine use of PROMs to drive quality improvement.
PROMs are standardised, validated questionnaires that patients complete, without any input from healthcare providers. They are often administered at least twice to an individual patient – at baseline and again after an intervention, or at regular intervals during a chronic illness. The information contributed by patients filling out PROMs questionnaires can be used to support and monitor the movement of health systems towards person-centred, value-based health care.
PROMs are being used to evaluate healthcare effectiveness at different levels of the health system, from the individual level to service and system levels. There is growing interest across Australia and internationally in the routine interrogation of patient-reported outcome information for evaluation and decision-making activities at levels of the health system beyond the clinical consultation.
Changes to indicators in the updated Hip Fracture Clinical Care Standard
The following changes have been made in the updated clinical care standard.
Changed
- Indicator 1b (now 1a) on screening for cognitive impairment to align with Indicator 1b of the Delirium Clinical Care Standard
Added
- Indicators 2b and 2c on the proportion of patients receiving a nerve block prior to surgery and prior to transfer from another hospital, where applicable
- Indicators 3a and 3b on assessing for clinical frailty and delirium
- Indicator 3c on the proportion of patients receiving protein and energy oral nutritional supplements
Retired
- Indicator 1a ‘Evidence of local arrangements for the management of patients with hip fracture in the emergency department’
- Indicator 2a ‘Evidence of local arrangements for timely and effective pain management for hip fracture’
- Indicator 3a ‘Evidence of orthogeriatric (or alternative physician or medical practitioner) management during an admitted patient’s hip fracture episode of care’
- Indicator 5b ‘Proportion of patients with a hip fracture with unrestricted weight bearing status immediately post hip fracture surgery’
- Indicator 5d ‘Proportion of patients with a hip fracture returning to pre-fracture mobility’
- Indicator 6b ‘Proportion of patients with a hip fracture readmitted to hospital with another femoral fracture within 12 months of admission from initial hip fracture’
- Indicator 7b ‘Proportion of patients with a hip fracture living in a private residence prior to their hip fracture returning to private residence within 120 days post separation from hospital’.
Changed
- Indicator 1b (now 1a) on screening for cognitive impairment to align with Indicator 1b of the Delirium Clinical Care Standard
Added
- Indicators 2b and 2c on the proportion of patients receiving a nerve block prior to surgery and prior to transfer from another hospital, where applicable
- Indicators 3a and 3b on assessing for clinical frailty and delirium
- Indicator 3c on the proportion of patients receiving protein and energy oral nutritional supplements
Retired
- Indicator 1a ‘Evidence of local arrangements for the management of patients with hip fracture in the emergency department’
- Indicator 2a ‘Evidence of local arrangements for timely and effective pain management for hip fracture’
- Indicator 3a ‘Evidence of orthogeriatric (or alternative physician or medical practitioner) management during an admitted patient’s hip fracture episode of care’
- Indicator 5b ‘Proportion of patients with a hip fracture with unrestricted weight bearing status immediately post hip fracture surgery’
- Indicator 5d ‘Proportion of patients with a hip fracture returning to pre-fracture mobility’
- Indicator 6b ‘Proportion of patients with a hip fracture readmitted to hospital with another femoral fracture within 12 months of admission from initial hip fracture’
- Indicator 7b ‘Proportion of patients with a hip fracture living in a private residence prior to their hip fracture returning to private residence within 120 days post separation from hospital’.