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The
British Orthopaedic Association, the British Geriatrics Society and the
Royal College of Physicians (London) are proposing a collaboration to
develop and pilot an audit tool to evaluate the medical and surgical care
of older people who fall and fracture.
In particular
the audit tool will evaluate the surgical management of fracture,
the medical assessment and management (orthogeriatric care) and secondary
prevention of falls and osteoporosis.
Link
between falls and bone health
Falls are a problem of national concern in providing health care. The
National Service Framework (NSF) for Older People has a chapter on falls
and requires all health services to provide integrated falls services
by April 2005. The NSF emphasises the link between falls and bone health.
The National Institute of Clinical Excellence (NICE) is currently developing
guidelines for the management of falls and for osteoporosis. In addition,
several recent guidelines have addressed the issue of falls.
Hip fracture
resulting from falls is a common condition, associated with significant
mortality and morbidity, and is costly to the NHS. It is a sentinel
event, is easily defined and embraces a population which can also readily
be identified. Such a situation greatly facilitates reliable and valid
audit and is akin to the successful Myocardial Infarction audit and stroke
audit currently running in England and Wales.
The surgical
component of hip fracture is already well audited e.g. the Scottish National
Hip Fracture Audit and the various regional UK audits. To date, however,
these audits do not include details related to the organisation of ortho-geriatric
services, and secondary prevention in terms of falls prevention and bone
health assessment.
Parallel
conditions
Stroke offers a similar paradigm in the care of older people
(and has a chapter next to falls in the NSF). The National Sentinel Audit
of Stroke is based on well established evidence based guidelines relating
to the organisation of services, the appropriate clinical management of
stroke patients, including the need for secondary prevention and on outcomes
of care. The audit has been successful in highlighting the variation and
limitations in stroke care around the country. It has been instrumental
in service development in many trusts.
Hip
fracture and orthogeriatric rehabilitation and associated secondary prevention
in terms of falls and bone health are analogous to stroke services.
There is a substantial evidence base to guide best practice. It will be
possible to develop hip fracture audit to enable a more comprehensive
evaluation of service provision to older people who fall and to meet the
requirements of the NSF to develop indicators of falls services.
Partners
in the study
The collaborative partners will be the BGS, which
through its special interest group on Falls and Bone Health has been
influential in the development of national guidelines and will bring
the required expertise to define an evidence base for an extended
hip fracture audit to include orthogeriatric management and secondary
prevention of falls and osteoporosis. The British Orthopaedic
Association incorporates representatives of the various clinical
teams currently carrying out hip fracture audit. The other partner,
the Royal College of Physicians (London), through
its Clinical Effectiveness and Evaluation Unit, has
an established track record in developing and carrying out national
audit, including stroke, myocardial infarction chronic obstructive
pulmonary disease and continence. |
Proposal:
1.
To define a unified data set from
current hip fracture audits for standardised national hip fracture
data collection.
2. To develop clinical indicators for evidence
based manage ment of:
a. Orthogeriatric assessment and rehabilitation
b. Secondary prevent of falls and osteoporosis
3. To incorporate the derived clinical indicators
from 2. above
into the hip fracture data set.
4. To pilot the comprehensive hip fracture/falls/bone
health
dataset.
5. To carry out a National audit
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Watch this
space.
Jonathan
Potter
Director, Health Care of Older People Programme
Clinical Effectiveness and Evaluation Unit
Royal College of Physicians, London
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