Pre-DIRECT

BACKGROUND

Hip fracture is a serious and common injury. Research has shown mortality rates as high as 30% at 12-months following hip fracture. In 2013 there were more than 61,000 hip fractures across England, Wales and Northern Ireland. There has been much research into the rates of mortality after hip fracture but systematic large-scale analysis of the causes of mortality is lacking. In order to improve the care and management of patients it is important to understand the causes behind the high mortality rates. We believe that analysing the causes of death in patients with hip fracture we will be able to explain the reasons for such high mortality rates.

AIM

To evaluate the consequences of patients who died after suffering from a hip fracture.

RESEARCH QUESTION

How and why patients die after suffering from a hip fracture?

METHODS

This study will draw on data that has already been collected by different systems. Firstly, the National Hip Fracture Database (NHFD) who collects data related to the care of people who break a hip bone across England, Wales and Northern Ireland. Second, Hospital Episode Statistics (HES) contains data on all hospital admissions and outpatient appointments at NHS hospitals. Finally, the Office of National Statistics (ONS) maintains a register of all deaths in the UK.

This study will identify all cases of hip fracture recorded by the NHFD and link these to data for the same patients in HES and ONS. The outcomes that will be used are death, length of stay, complications, disability level, need for re-operation or re-admission to hospital, and quality of life. In this way, we will be able to understand how service design has responded to national best practice guidelines and how these clinical pathways predict clinical outcomes and cost across England. At each stage, the study will use statistical techniques to account for differences (e.g. age and surgical treatment) between the patients treated.

IMPACT

This study can provide better patient care and improved mortality in this condition. This benefit would be realised incrementally as changes in practice are adopted by the wider medical community over the following months and years.

There will be no specific date that we could feasibly identify when such an improvement could be achieved.

STUDY TEAM

The study will be led by researchers from the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences based at the University of Oxford.

DATA SOURCES

The FFAP (Fragility Fracture and Falls Audit Programme) periodically send data to NHS Digital who link the records to ONS, HES and other national health datasets and get details of your registered GP practice via a process known as List Cleaning. In order to link the data, we need to provide identifiable data (NHS number, name, date of birth and postcode) to NHS Digital. By linking the data together, we are able to look at more aspects of quality of care without asking hospitals to enter more information into our database.

Data is supplied to the University of Oxford for analysis but this is done so that no individual patient can be identified. The University of Oxford team do receive date of death for patients who have died following their injury - this is so we can monitor rates of mortality in hospitals across the country for patient safety reporting. Reports produced by the audit will not contain NHS numbers or any other information that could be used to identify anyone. Participant’s data will be stored under the University of Oxford Information Governance Policies. Data will be stored for a maximum of 36 months. Data is also send by Crown Informatics to our team at the Royal College of Physicians, so that we can review the quality of the data, support hospital teams who are finding it difficult and manage the ‘day to day’ running of the work.

Data Processing

The lawful bases for processing of your data under GDPR are:

Article 6(1)(e) (processing is necessary for the performance of a task in the public interest or in the exercise of official authority vested in the controller)

Article 9(h) (processing is necessary for the purposes of preventative or occupational medicine, for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services on the basis of Union or Member State law or pursuant to contract with a health professional and subject to the conditions and safeguards referred to in paragraph 3;)