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High quality of care did not imply increased hospital spending- nationwide cohort study among hip fracture patients.

Objective
To examine whether fulfilment of process performance measures reflecting national guidelines is associated with in-hospital costs among hip fracture patients.


Design
Nationwide, population-based follow-up study.


Setting
Public hospitals in Denmark.


Participants
A total of 20 458 patients 65 years or older admitted with a hip fracture between 2010 and 2013.


Intervention
Quality of care defined as fulfilment of process performance measures reflecting recommendations from national clinical guidelines, which previously have been shown to be associated with lower mortality and readmission risk. The measures included systematic pain assessment; mobilisation within 24 h post-operatively; assessment of basic mobility before admission and discharge; and receiving a rehabilitation programme before discharge, anti-osteoporotic medication and fall prevention.


Main outcome measures
Total costs defined as the sum of hospital costs used for treating the individual patients according to the Danish Reference Cost Database.


Results
Within the index admission, fulfilling 50 to >75% of the performance measures was associated with lower adjusted costs (EUR 2643) than was fulfilling 0-50% of these measures (EUR 3544). The lower costs were mainly due to savings on further treatment and fewer bed days. Mobilisation within 24 h after surgery and assessment for need of anti-osteoporotic medication were associated with the largest cost differences, corresponding to adjusted cost differences of EUR 3030 and EUR 3538, respectively. The cost difference was lower when all costs related to hospitalisation within the first year were considered.


Conclusions
These findings indicate that high quality of care does not imply higher hospital spending and may be associated with cost savings.