Implementing a hip fracture registry and financial incentive program to enhance best practice in hip fracture care in Western Australia

Abstract

Hip fracture is a common injury in older adults that causes significant morbidity and mortality. Older adults who sustain a hip fracture are at a higher risk of institutionalisation, reduced mobility and subsequent falls and, consequently, have increased rates of morbidity and mortality. Quality improvement strategies that address gaps in hip fracture care are needed to ensure best practice and improve health outcomes for older adults. This case study describes the development of a state-based hip fracture registry and incentive payment scheme in Western Australia (WA), which were designed to drive quality improvement. The registry monitored best practice in hip fracture care criteria across three tertiary hospitals in WA, and the incentive program provided premium payments to these hospitals for meeting six criteria in best practice clinical quality. The fracture registry commenced in 2011, and by 2014 all participating hospitals were eligible for payments. From 2014 to 2016, the proportion of patients who were operated on within 36 hours increased from 60% to 79%. This case study illustrates how a hip fracture registry in conjunction with small premium payments improved well-described process measures in hip fracture care. What is known about the topic?Hip fracture is a common among older adults, usually resulting from a fall. International clinical quality registries have been shown to help drive quality improvements in patient care processes and outcomes. What does this paper add?This paper adds an Australian perspective to the existing literature on the efficacy of hip fracture clinical quality registries. It offers an example of how a Western Australian hip fracture registry with an associated incentive payment program drove clinical care and process change to improve care provision and patient outcomes. What are the implications for practitioners?This case study suggests regular monitoring and reporting on hip fracture care processes and patient outcomes can lead to improvements in both of these measures. Because incentive payments may have contributed to the best practice improvements noted in this case study, practitioners involved in designing future monitoring and reporting programs should consider the merits of incorporating financial incentives.