Background The UK National Hip Fracture Database (NHFD) is a clinician-led audit initiative launched in 2007 as a collaboration between the British Geriatrics Society and the British Orthopaedic Association. The BOA/BGS published six national clinical standards for hip fracture care, including early surgery (within 48 hours) and access to acute geriatric care. The NHFD uses data collection and feedback to support hospital clinical teams in monitoring their performance against these standards and improving their care.
Methods We used routinely collected non-audit data on 471,590 older people (aged ≥ 60 years) admitted with a hip fracture to National Health Service hospitals in England between 2003 and 2011. We compared time trends in mortality in the periods 2003-2007 and 2007-2011 (before and after the launch of the NHFD), using Poisson regression models to adjust for demographic changes. Absolute reductions in adjusted 30-day mortality were expressed in percentage points calculated from model predictions weighted to the age and sex distribution of the sample over the entire study period.
Findings The number of hospitals participating in the NHFD increased from 11 in 2007 to 175 in 2011. From 2007 to 2011, 30-day mortality fell from 10.9% to 8.5%, compared to a small reduction from 11.5% to 10.9% previously. The absolute reduction in adjusted 30-day mortality over the period 2007–2011 was 2.9%, compared with a smaller decrease of 1.0% over the period 2003–2007.
Interpretation The launch of a national clinician-led audit initiative (the NHFD) was associated with substantial improvements in survival of older people with hip fracture in England. The results suggest that by 2011, around 1,000 fewer people a year died within 30 days of hospital admission for hip fracture than would be expected had pre-2007 time trends continued as before.