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 measurements on the evaluation of quality of care, comparing different health care providers. We performed a cross-sectional study in 3 medical centers. Three hundred three patients undergoing surgical repair of traumatic femoral neck fracture were included. Trained nurses gathered data by patient and proxy interview and by chart abstraction. Multivariate analysis was performed to obtain an explanatory model for each outcome. Then, the additional contribution of each of the centers to the explanatory power of the model was examined. The outcomes were mortality, functional capacity, postoperative complications, and length of stay. Explanatory variables included were sociodemographic details, comorbidity 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 functional capacity but a "good" outlier for length of stay. We conclude that outcome studies for quality assurance programs should include all relevant outcomes, as the assumption that one major outcome may be representative for quality of care assessment may be misleading.