Table 3.

Institute of Medicine Dimensions and Institute for Healthcare Improvement Whole System Measures to set priorities for implementing the VFC

IOM Dimension	Fracture Management Re-design	IHI Whole System Measure
Effective	Providing an evidence-based service to manage Orthopaedic fracture	Realiability of core measures Functional Health Outcomes Score Hospital re-admission percentage
Safe	By avoiding preventable harm including over-treating injuries or mismanaging complex ones, and ensuring appropriate surgical or conservative management provided by trained specialists	Rate of Adverse Events
Patient-centered	By providing a fracture management plan that is individually tailored to a patient's own needs and values and socioeconomic factors, and enabling the patient to take responsibility for their own care	Patient Experience Score Patient Satisfaction with Care Score
Timely	By providing a fracture management service in a timely manner. Orthopaedic injuries can be very painful, and there is a defined window of opportunity for surgical intervention	Days to next available appointment/specialist review
Equitable	Irrespective of the geographic location or the tertiary trauma capability of the hospital which the patient attends, and independent of local pressures on resources, the quality of care should not vary. Patients should be able to be transferred to super-specialist centers (e.g. poly-trauma or hand) where necessary, and the management plan should not deviate due to availability of resources or economic factors.	Equity Stratification
Efficient	By provideing a fracture serivce which is an efficient use of A&E and Orthopaedic department resources to provide value to the populatin which it serves	Health care cost / capita