Objectives Despite established standards and guidelines, substantial variation remains in the delivery of hip fracture care across the United Kingdom. We aimed to determine which hospital-level organisational factors predict adverse patient outcomes in the months following hip fracture. Methods We examined a national record-linkage cohort of 178,757 patients aged ≥60 years who sustained a hip fracture in England and Wales in 2016–19. Patient-level hospital admissions datasets, National Hip Fracture Database and mortality data were linked to metrics from 18 hospital-level organisational-level audits and reports. Multilevel models identified organisational factors, independent of patient case-mix, associated with three patient outcomes: length of hospital stay (LOS), 30-day all-cause mortality and emergency 30-day readmission. Results Across hospitals mean LOS ranged from 12 to 41.9 days, mean 30-day mortality from 3.7 to 10.4% and mean readmission rates from 3.7 to 30.3%, overall means were 21.4 days, 7.3% and 15.3%, respectively. In all, 22 organisational factors were independently associated with LOS; e.g. a hospital’s ability to mobilise >90% of patients promptly after surgery predicted a 2-day shorter LOS (95% confidence interval [CI]: 1.2–2.6). Ten organisational factors were independently associated with 30-day mortality; e.g. discussion of patient experience feedback at clinical governance meetings and provision of prompt surgery to >80% of patients were each associated with 10% lower mortality (95%CI: 5–15%). Nine organisational factors were independently associated with readmissions; e.g. readmissions were 17% lower if hospitals reported how soon community therapy would start after discharge (95%CI: 9–24%). Conclusions Receipt of hip fracture care should be reliable and equitable across the country. We have identified multiple, potentially modifiable, organisational factors associated with important patient outcomes following hip fracture.

中文翻译：

---

多种医院组织因素与英格兰和威尔士髋部骨折后不良患者预后相关：REDUCE 记录关联队列研究

目标 尽管制定了标准和指南，但英国各地髋部骨折护理的提供仍存在很大差异。我们的目的是确定哪些医院级别的组织因素可以预测髋部骨折后几个月内患者的不良结果。方法 我们检查了 2016-19 年在英格兰和威尔士发生髋部骨折的 178,757 名年龄≥60 岁的全国记录关联队列。患者入院数据集、国家髋部骨折数据库和死亡率数据与来自 18 个医院级组织级审计和报告的指标相关联。多层次模型确定了组织因素，独立于患者病例组合，与三种患者结果相关：住院时间 (LOS)、30 天全因死亡率和紧急 30 天再入院。结果 各医院的平均 LOS 范围为 12 至 41.9 天，平均 30 天死亡率为 3.7 至 10.4%，平均再入院率为 3.7 至 30.3%，总体平均值分别为 21.4 天、7.3% 和 15.3%。总共有 22 个组织因素与 LOS 独立相关；例如，医院能够在手术后迅速调动＞90% 的患者，预测 LOS 缩短 2 天（95% 置信区间 [CI]：1.2-2.6）。10 个组织因素与 30 天死亡率独立相关；例如，在临床管理会议上讨论患者体验反馈和为超过 80% 的患者提供及时手术均与降低 10% 的死亡率相关（95%CI：5-15%）。九个组织因素与再入院独立相关；例如 如果医院报告出院后多久开始社区治疗，再入院率会降低 17% (95%CI: 9–24%)。结论 髋部骨折护理的接收在全国范围内应该是可靠和公平的。我们已经确定了与髋部骨折后重要患者预后相关的多个可能可修改的组织因素。