Does comparison of performance lead to better care? A pilot observational study in patients admitted for hip fracture in three French public hospitals

Abstract

OBJECTIVE: To assess whether comparison of quality of hip fracture care among three teams located in different hospitals is associated with improvement in process and outcomes. DESIGN: A baseline assessment was performed using quality indicators selected by professionals. RESULTS: were discussed among the three teams followed by a post-comparison assessment of the same indicators. SETTING: Three hospitals in North Western France. PARTICIPANTS: Professionals caring for patients operated on for a low-impact hip fracture. INTERVENTION: Review and discussion of comparative performance results by three teams followed by implementation of quality improvement as deemed necessary by each team. MAIN OUTCOME MEASURES: Fifteen quality indicators of health care during orthopedic and rehabilitation stay, mobility, dependence and place of residence before hip fracture and 3 months after discharge, 3 month post-surgery mortality and readmission rates. RESULTS: Major differences were observed among hospitals throughout the care process during baseline period. Comparison of performance and discussion among the three teams were followed by corrective action in 11 areas. After comparison, a significant improvement was observed in 10 areas, seven of which corresponded to quality improvement areas chosen for improvement action by professionals. A significant decrease in readmission rate (6.7% vs. 15.7%, P < 0.001) was observed but there was no change in mortality, functional outcome or length of stay. CONCLUSIONS: Comparison of performance among voluntary teams, on fields selected by health-care professionals, was associated with improvement in the care process and with improvement of some related outcomes.