Comparing medical centers treating hip fractures in the elderly: The importance of multi-outcome measurements

The objective of this study was to assess the merit of multi outcome measur ements on the evaluation of quality of care, comparing different health car e providers. We performed a cross sectional study in 3 medical centers. Thr ee hundred three patients undergoing surgical repair of traumatic femoral n eck fracture were included. Trained nurses gathered data by patient and pro xy inter view and by chart abstraction. Multivariate analysis was performed to obtain an explanatory model for each out come. Then, the additional con tribution of each of the centers to the explanatory power of the model was examined. The outcomes were mortality, functional capacity, postoperative c omplications, and length of stay. Explanatory variables included were socio demographic details, co morbidity indices, preoperative functional capacity , depression, and cognition. The results demonstrated that center A was a " good" outlier for mortality rate but, in contrast, was a "bad" outlier for complication rate and length of stay. Center B was a "bad" outlier for func tional capacity but a "good" outlier for length of stay. We con elude that outcome studies for quality assurance pro grams should include all relevant outcomes, as the assumption that one major outcome may be representative f or quality of care assessment may be misleading.