Hip Fracture Affects More Than the Hip Pocket
Currently in Australia, more than 16,000 people break their hip every year. All of these people will be admitted to hospital, and most will have some kind of surgery. A year later, less than half will be able to walk as well as they did, and sadly, another 6 - 7% will have died.
On top of the emotional cost, the financial burden of hip fracture is extremely high with an estimated annual bill in Australia of more than $1 billion per year. On April 27, The George Institute and NSW Agency for Clinical Innovation held a seminar on hip fracture, which was sponsored by the Agency for Clinical Innovation. Professor Keith Willett, National Clinical Director for Trauma Care, Department of Health, UK Government, spoke about a new policy in the UK relating to hip fracture.
The policy involves paying hospitals only if they achieved all of the critical standards of health care. For example, surgery within 36 hours of admission, multidisciplinary care and geriatric medical assessment were included in key indicators. Initially hospitals were kept anonymous but now they are named, providing added incentive for optimum performance. Outcomes for hip fracture patients have improved enormously as a result of this program. It is hoped that a similar database may commence in NSW and potentially nationally, which would provide the evidence to show where investment was needed in this country.
About 10% of all hip fractures worldwide occur in China. There are currently eight million 80-year-olds in China. This figure is expected to increase to 100 million by 2050 which will place significant pressures on health services, and put high treatment costs onto individuals and families without the means to pay for it. The rapid ageing in China has led to an aged population with only 8% of the average income compared to that in the UK or Australia. The George Institute, together with partners in Beijing and Oxford (including Keith Willett) will soon commence a study that aims to improve the management of hip fracture in China, and minimise the financial impact.
It is anticipated that this may lead to further research into new approaches to prevention, treatment and rehabilitation, early supported discharge, sustainable lowcost quality improvement programs and the evaluation of new hospital pathways or models of care.
Richard Lindley, Professorial Fellow at The George Institute, commented, “The UK experience has demonstrated that substantial improvements in hip fracture care can be achieved guided by good data, and a brave Department of Health who were prepared to use a carrot and stick approach to hospital funding. Whether we can replicate an adapted version of this in Australia (or China) will be part of the focus of The George Institute work in this area”.