Spain has one of the world’s highest life expectancies, and its rapidly ageing population is putting the health system under strain. Improvement of quality of care for elderly people is an imperative to improve outcomes and reduce costs.
Approximately 50 000 hip fractures occur in Spain every year and cost more than 2.5% of total health expenditur. One year after a hip fracture, 25% of Spanish patients will have died and 60% will have limited mobility or other dysfunction.
For 3 years, the Spanish National Hip Fracture Registry – comprising over 200 doctors from 75 Spanish hospitals – has been collecting comprehensive data on the management of elderly patients with hip fractures and is already making a difference to quality of care.
This Registry, coordinated by the Aging and Frailty in Older People group at the Hospital La Paz Institute for Health Research, is the winner of the 2019 State of Kuwait Health Promotion Foundation Prize for research in healthcare for the elderly and health promotion.
The Aging and Frailty in Older People research group was initiated in 2016 by a multidisciplinary group throughout Spain. Registry members participate on a voluntary basis by sharing their patients’ data regularly. Coming from all sorts of medical backgrounds - geriatricians, internists, orthopaedic surgeons, anaesthesiologists, clinicians and nurses, they are all dedicated to hip fracture care. They treat these patients at different phases, in the hospital and on discharge. Coordination results in improved quality of care.
“The Registry allows us to analyse issues experienced in each participating hospital, and make comparisons between hospitals, regions of Spain and even other countries,” says Dr Pilar Sáez, a geriatrician who serves as the Registry’s National Coordinator. “All participating hospitals can access and assess their results, spotting the best practice of care and also areas where we can improve. We have already made major progress in addressing delay of surgery and secondary prevention of fractures.”
“Gathering and analyzing data is fun,” says Dr Cristina Ojeda-Thies, an orthopaedic surgeon dedicated to the management of fractures. “Although I get the best ideas when solving problems during surgery, I still want convince my colleagues that we can learn a lot from statistics; understanding data to improve quality of care is very rewarding.”
The award recipients describe how this field of care has evolved. A few decades ago, elderly patients with fractures were treated by orthopaedists only. Geriatric specialists have increasingly come on board and, as a result, treating patients with hip fractures has enormously improved. Dr Saez is a pioneer in ortho-geriatrics, having introduced it in several hospitals in Spain.
“The elderly suffer complex problems that constrain the normal functioning of the body,” she says. “This challenges us, healthcare professionals and researchers alike. But solutions exist, and the quality of life of older people can significantly improve with simple measures that address their health issues.”
Improvements in quality and efficiency of elderly care can be made through prevention of fragility hip fractures, improved management of incident fractures, and better care to prevent secondary complications.
The Registry’s members help one another to find the best solutions by coordinating through care pathways and regular communication.
“Elderly people deserve the highest respect,” says Dr. Paloma Gómez-Campelo, a psychologist and researcher, Assistant Director of the Hospital La Paz Institute for Health Research. “This includes quality healthcare, to allow for the best quality of life for the people who have helped build the society we currently enjoy.”
The healthcare professionals and the researchers work on a voluntary basis, as the Registry does not receive financial support from public institutions and depends on private funds and research grants to keep functioning. The award will allow the Registry to recruit administrative and statistics personnel, which will make it possible to continue this important work.