Effect of the quality of health care on permanent inability secondary to femoral fractures due to occupational accidents

Objective. To construct and validate an indicator for evaluating the qualit y of care for femoral fractures, and to assess the contribution of the qual ity of health care as a determinant of partial permanent inability secondar y to femoral fractures due to occupational accidents. Materials and methods . The study was conducted from January to December 1995 at Mexican Institut e of Social Security. The instrument was designed with experts' contributio n along different stages and validated using implicit criteria and factoria l analysis. A case-control study was then conducted to evaluate the contrib ution of the quality of care to inability secondary to femoral fractures. C ases were 108 active workers with permanent inability secondary to femoral fracture; controls were 94 active workers with fracture of femur but no per manent inability. Logistic regression modeling was used to establish the as sociation between quality of care and partial permanent inability, adjustin g by relevant variables. Results. The ultimate indicator of quality of care consisted of the following:Timely care, presurgical management, surgical m anagement, and fracture complications. A final score over 229 points meant that the worker had received good quality of care. Workers getting 229 or l ess points had received poor quality of care. Forty-eight (44%) cases and 6 6 (70%) controls received good quality of medical care. The likelihood of p artial permanent inability was almost three times higher among workers give n poor quality of care (OR 2.95;95% CI 1.5 - 5.5). According to the multiva riate model, predictors of partial permanent inability were: Having exposed or epiphysiary fractures, being re-submitted to surgery, having less than 90 days of rehabilitation care,and receiving deficient medical care. Conclu sions. The constructed instrument was validated. The level of the quality o f care received by workers is a determining factor for the generation of pa rtial permanent inability. In workers having femoral fractures, it is impor tant to consider timely medical care and early rehabilitation, to reduce th e high incidence and prevalence of this medical problem in Mexico. The Engl ish version of this paper is available too at: http://www.insp.mx/salud/ind ex.html.