DOS 2017

DOS Kongressen 2017 ·

Is High Quality Of Care Associated With Higher Costs?

- A Nationwide Cohort Study Among Hip Fracture Pa-

tients

Pia Kjær Kristensen, Rikke Søgaard, Theis Thillemann, Kjeld Søballe, Søren Paaske

Johnsen

Orthopaedic department and Department of clinical Epidemiology, Horsens and

Aarhus University Hospital; Public Health, Aarhus University; Orthopeadic De-

partment, Aarhus University Hospital; Orthopeadic Department, Aarhus Uni-

versity Hospital; Department of Clinical Epidemiology, Aarhus Univerity Hospital

Background:

It is unknown whether improvements in quality of care will require

increased health care spending or whether improvements in quality of care will

lead to a reduction in adverse patient outcomes, including fewer complications

and readmissions.

Purpose / Aim of Study:

To examine whether fulfilment of process perfor-

mance measures reflecting national guideline are associated with hospital costs

among hip fracture patients

Materials and Methods:

We identified 20,458 hip fracture patients ≥ 65

years based on prospectively collected data from the Danish Multidisciplinary

Hip Fracture Registry. Quality of care were defined as fulfilment of seven pro-

cess performance measures from the national multidisciplinary guideline for

in-hospital care: systematic pain assessment, early mobilisation, basic mobil-

ity assessment before admission and discharge, post discharge rehabilitation

program, anti- osteoporotic medication and prevention of future fall accidents.

Total costs were defined as the sum of costs used for treating the individual

patient according to the Danish Reference Cost Database.

Findings / Results:

Fulfilment of the individual process performance measures

were associated with lower total costs within the index admission. The adjust-

ed ratio ranged from 0.90 (95% Confidence Interval (CI): 0.88-0.91) to 0.97

(95% CI: 0.95-0.99), corresponding to adjusted mean differences between

EUR305 to EUR3534 when compared to patients where the care did not fulfil

the measures. Receiving between 50% to 75% or more than 75% of the per-

formance measures were also associated with lower total costs. The association

were weakened when taking into account all costs related to hospitalisations

within the first year.

Conclusions:

High quality of care appear not to imply increased spending and

may even lead to lower hospital costs for the index admission and within the

first year.

No conflicts of interest reported

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