HEALTHCAR E DE LIVE RY
care, there may be scope to reduce the length of hospital stays for hip fracture patients and free up additional capacity to deal with the backlog of care.
In contrast to England, countries such as the Netherlands, Sweden and Canada have been able to provide accessible post-hospital care for hip fracture rehabilitation in either community-based or short-term residential care settings, resulting in much shorter hospital stays than patients in England. High mortality among hip fracture patients is occurring despite England performing well on other care quality measures – for example, over 82% of hip fracture patients in England received hip surgery within 48 hours of admission, second only to 85% of patients in Sweden. This is recommended as a key component of high-quality care. However, one year after their initial admission, 31% of English patients had died, compared with only 25% of Swedish patients. Dr. Jennifer Dixon, chief executive of the
Health Foundation, said: “The findings of the ICCONIC study warrant urgent further investigation, particularly the finding of higher mortality among patients with hip fracture in the year after their admission for emergency treatment. The study suggests there is a significant opportunity to achieve higher quality care for patients, in part by learning from how other health systems deliver care and the investment it takes to do so. That patients in England with hip fracture spend far longer in hospital after surgery than they would in other countries also highlights an opportunity to improve efficiency by reducing the avoidable use of hospital care. Less avoidably long stays would mean existing capacity could be better used to address the backlogs in hospital care as a result of the pandemic. This could contribute to both better outcomes for patients and – as hip fracture is the most common reason for emergency surgery – significantly improve productivity for hospitals across the country. “This ICCONIC study is innovative in using patient level data to compare the quality of care across different health systems. The findings should be viewed
alongside other comparative studies which together can give a more rounded picture of the performance of the health system in England relative to other countries for the investment made. “The study also highlights the lack of high-quality data that is available across the wider system of health and care which limits our understanding of what is happening on the ground, and the ability of clinical teams and NHS policymakers to act to improve care. However, there is now a clear opportunity with the introduction of new integrated care systems to make a step change in terms of linking up patient data and using the insights generated by this to reduce delays in discharge and improve quality of care and patient experience.” Dr. Irene Papanicolas, associate professor of health economics at the London School of Economics, said: “The ICCONIC study is unique in that it compares similar patients care trajectories across the health and care systems within their own countries. This perspective allows us to compare how efficient and effective different countries are in caring for patients with high needs. England stands out both because of the low cost with which it is able to provide care. However, England also has higher year-long mortality than other countries participating in the study. Further work is needed to understand what England can do to improve patient outcomes.”
High mortality among hip fracture patients is occurring despite England performing well on other care quality measures – for example, over 82% of hip fracture patients in England received hip surgery within 48 hours of admission, second only to 85% of patients in Sweden.
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Caring for older patients with complex needs
A Health Foundation long read, Caring for older patients with complex needs, details the findings of the ICCONIC study for England and how England compares internationally.
CSJ
On the findings for heart failure in the ICCONIC study, the Health Foundation says that the relatively high mortality observed for patients in England is likely to be, at least partly, the product of the way in which care for heart failure is delivered in different countries. Patients have been selected for inclusion in the study based on being admitted to hospital with heart failure. In countries like England (where patients receive more of their care via general practice) only serious cases are admitted to hospital, whereas in other countries care is more hospital-based, meaning patients selected for inclusion may be less sick to begin with. By contrast, in any country, hip fractures almost always require hospital admission for surgery. However, the Health Foundation also notes that there is room for improvement in the assessment, diagnosis and management of heart failure. The National Heart Failure Audit has found that rates of specialist follow-up for heart failure patients are below 50%, less than half of patients are seen on a dedicated cardiology ward, and rates of referral for cardiac rehabilitation are very poor. This latter point is particularly concerning given that patients who received rehabilitation have higher quality of life and lower mortality. Visit:
https://health.org.uk/ publications/long-reads/caring-for-older- patients-with-complex-needs
JANUARY 2022
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