| Title: |
Following hip fracture, hospital organizational factors associated with prescription of anti-osteoporosis medication on discharge, to address imminent refracture risk: a record-linkage study |
| Authors: |
Patel, Rita; Judge, Andrew; Johansen, Antony; Javaid, Muhammad K.; Griffin, Xavier L.; Chesser, Tim; Griffin, Jill; Marques, Elsa M. R.; Gregson, Celia L.; Ben-Shlomo, Yoav; Drew, Sarah; Whale, Katie |
| Publisher Information: |
American Society for Bone and Mineral Research |
| Publication Year: |
2024 |
| Collection: |
Cardiff University: ORCA (Online Research @ Cardiff) |
| Description: |
Patients who sustain a hip fracture are known to be at imminent refracture risk. Their complex multidisciplinary rehabilitation needs to include falls prevention and anti-osteoporosis medication (AOM) to prevent such fractures. This study aimed to determine which hospital-level organizational factors predict prescription of post-hip fracture AOM and refracture risk. A cohort of 178 757 patients aged ≥60 yr who sustained a hip fracture in England and Wales (2016-2019) was examined and followed for 1 yr. Patient-level hospital admission datasets from 172 hospitals, the National Hip Fracture Database, and mortality data were linked to 71 metrics extracted from 18 hospital-level organizational reports. Multilevel models determined organizational factors, independent of patient case-mix, associated with (1) AOM prescription and (2) refracture (by ICD10 coding). Patients were mean (SD) 82.7 (8.6) yr old, 71% female, with 18% admitted from care homes. Overall, 101 735 (57%) were prescribed AOM during admission, while 50 354 (28%) died during 1-yr follow-up, 12 240 (7%) refractured. Twelve organizational factors were associated with AOM prescription, for example, orthogeriatrician-led care compared to traditional care models (odds ratio [OR] 4.65 [95% CI, 2.25–9.59]); AOM was 9% (95% CI, 6%–13%) more likely to be prescribed in hospitals providing routine bone health assessment to all patients. Refracture occurred at median 126 d (IQR 59–234). Eight organizational factors were associated with refracture risk; hospitals providing orthogeriatrician assessment to all patients within 72 h of admission had an 18% (95% CI, 2%–31%) lower refracture risk, weekend physiotherapy provision had an 8% (95% CI, 3%–14%) lower risk, and where occupational therapists attended clinical governance meetings, a 7% (95% CI, 2%–12%) lower risk. Delays initiating post-discharge community rehabilitation were associated with a 15% (95% CI, 3%–29%) greater refracture risk. These novel, national findings highlight the importance of ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
English |
| Relation: |
https://orca.cardiff.ac.uk/id/eprint/171967/1/zjae100.pdf; Patel, Rita, Judge, Andrew, Johansen, Antony, Javaid, Muhammad K., Griffin, Xavier L., Chesser, Tim, Griffin, Jill, Marques, Elsa M. R., Gregson, Celia L., Johansen, Antony https://orca.cardiff.ac.uk/view/cardiffauthors/A26509918.html, Chesser, Tim, Javaid, Muhammad K., Griffin, Xavier L., Griffin, Jill, Marques, Elsa M. R., Ben-Shlomo, Yoav, Drew, Sarah, Judge, Andrew, Patel, Rita, Whale, Katie, Ben-Shlomo, Yoav and Gregson, Celia L. 2024. Following hip fracture, hospital organizational factors associated with prescription of anti-osteoporosis medication on discharge, to address imminent refracture risk: a record-linkage study. Journal of Bone and Mineral Research (JBMR) 39 (8) , pp. 1071-1082. 10.1093/jbmr/zjae100 https://doi.org/10.1093/jbmr%2Fzjae100 file https://orca.cardiff.ac.uk/id/eprint/171967/1/zjae100.pdf |
| DOI: |
10.1093/jbmr/zjae100 |
| Availability: |
https://orca.cardiff.ac.uk/id/eprint/171967/; https://doi.org/10.1093/jbmr/zjae100; https://orca.cardiff.ac.uk/id/eprint/171967/1/zjae100.pdf |
| Rights: |
cc_by_4_0 |
| Accession Number: |
edsbas.791F7CF5 |
| Database: |
BASE |