Does achieving the 'Best Practice Tariff' criteria for fractured neck of femur patients improve one year outcomes?

Introduction: 'Best Practice Tariff' (BPT) criteria have been developed to improve peri-operative care for hip fracture patients. This paper aims to explore the impact of BPT criteria on 1-year outcomes.

Patients And Methods: Anonymised data were acquired from the National Hip Fracture Database (NHFD) for patients presenting to Bradford Royal Infirmary with a fractured neck of femur during the period April 2011 to December 2015. Two study groups were defined: those that achieved the BPT uplift criteria, and those that did not. Three primary outcome measures were identified: one year survival, mobility status and residential status. Further analysis was performed to ascertain whether achieving any individual BPT criterion significantly affected 1-year outcomes.

Results: 1414 cases were included, 784 (55%) of whom met the BPT criteria. The 1-year survival rate of the BPT-achieved group was 67.7%, compared with 61.4% in the non-BPT group (relative risk reduction 10.3%, p = 0.014). Mobility status declined by at least one grade in 50.8% of the BPT-achieved group, compared with 60.8% of the non-BPT group (risk reduction 16.4%, p = 0.003). BPT achievement had no significant effect on residential status at one year. Multivariate analysis identified that post-operative Abbreviated Mental Test Score (AMTS) and falls assessment were significantly associated with reduced 1-year mortality. Similarly, both pre- and post-operative AMTS assessments resulted in greater potential to return to pre-morbid mobility level. When controlling for potential confounders (age, gender, ASA grade, pre-morbid mobility and residential status) logistic regression modelling showed that achieving the BPT criteria was associated with a 30% increase in the odds of survival at one year (p = 0.046).

Discussion: Achieving the BPT requirements has a significant impact on 1-year mortality and return to pre-morbid mobility level. The effect of AMTS and falls assessments on these outcomes may be due to their properties as surrogate markers for more thorough and considered peri-operative assessment.

Conclusions: Few studies describe the effect of BPT criteria on 1-year outcomes; therefore the results presented here help to vindicate the investments made in the scheme. Furthermore, these results may help steer subsequent revisions to BPT requirements by encouraging greater focus on peri-operative assessment and interventions.