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Indicator Metadata

NameIn-Hospital Hip Fracture in Elderly (65+) Patients
Short/Other Names

In-Hospital Hip Fracture (65+)

Description

This indicator measures the rate of in-hospital hip fractures among acute care inpatients age 65 and older.

For further details, please see the General Methodology Notes.

InterpretationLower rates are desirable.
HSP Framework Dimension

Health System Outputs: Safe

Areas of Need

Getting Better

Geographic Coverage

All provinces/territories except Quebec

Reporting Level/Disaggregation

National, Province/Territory, Region, Facility, Peer Group

Indicator Results

https://www.cihi.ca/en/cihi-health-indicators

Identifying Information
NameIn-Hospital Hip Fracture in Elderly (65+) Patients
Short/Other Names

In-Hospital Hip Fracture (65+)

Indicator Description and Calculation
Description

This indicator measures the rate of in-hospital hip fractures among acute care inpatients age 65 and older.

For further details, please see the General Methodology Notes.

Calculation: Description

The indicator is expressed as a rate of in-hospital hip fractures per 1,000 inpatient cases.

Risk-adjusted rate = Observed cases ÷ Expected cases × Canadian average

Unit of analysis: Single admission

Calculation: Geographic Assignment

Place of service

Calculation: Type of Measurement

Rate - per 1,000

Calculation: Adjustment Applied

The following covariates are used in risk adjustment:
For a detailed list of covariates used in the model, please refer to the Model Specification document.

Calculation: Method of Adjustment

Poisson regression

Denominator

Description:
Acute care discharges of patients age 65 and older
Inclusions:
1. Admission to an acute care institution (Facility Type Code = 1)

2. Age at admission 65 years and older

3. Sex recorded as male or female
Exclusions:
1. Records with admission category of cadaveric donor or stillbirth (Admission Category Code = R or S)

Numerator

Description:
Cases within the denominator with a post-admission hip fracture
Inclusions:
1. One of the following ICD-10-CA codes, coded as type 2:

  • Fracture of neck of femur (S72.0)
  • Intertrochanteric fracture (S72.10)
  • Unspecified trochanteric fracture (S72.19)
  • Subtrochanteric fracture (S72.2)
    Exclusions:
    1. Other specified misadventures during surgical and medical care (one of the above S codes and Y65.8 coded as type 9)

OR

2. Fracture of bone following insertion of orthopedic implant, joint prosthesis or bone plate (M96.6 coded as type 2 or T81.88 coded as type 2)

Background, Interpretation and Benchmarks
Rationale

With nearly 1 in every 1,000 elderly patients (age 65 and older) suffering a hip fracture after admission to a Canadian acute care hospital,* in-hospital hip fractures remain a significant patient safety concern.

The rate and risk of patient falls resulting in hip fracture increase with age.

Other known risk factors include cognitive impairment, gait or balance instability, weakness and the use of certain medications.

In addition to the profound impact hip fractures can have on the independence and quality of life of elderly patients, such injuries occurring within hospital are also associated with longer lengths of stay and increased health care costs. Thus patient falls represent an important issue for hospital risk management. Many falls and their consequences are potentially preventable by knowing about and identifying known risk factors

This indicator is intended to help hospitals monitor prevention efforts; high rates should be used to identify areas for improvement.

Note
*Based on data from CIHI's Discharge Abstract Database from 2000–2001 to 2002–2003, excluding patients from Quebec and Manitoba.

Interpretation

Lower rates are desirable.

HSP Framework Dimension

Health System Outputs: Safe

Areas of Need

Getting Better

Targets/Benchmarks

Not applicable

References

Corsinovi L, Bo M, Ricauda AN, et al. Predictors of falls and hospitalization outcomes in elderly patients admitted to an acute geriatric unit. Archives of Gerontology and Geriatrics. July 2009.

Johal KS, Boulton C, Moran CG. Hip fractures after falls in hospital: A retrospective observational cohort study. Injury. February 2009.

Oliver D, Daly F, Martin FC, McMurdo ME. Risk factors and risk assessment tools for falls in hospital in-patients: A systematic review. Age and Ageing. March 2004.

Pulcins I, Wen E. In-hospital hip fractures in Canada: Using information to improve patient safety. Healthcare Quarterly. 2004.

Salgado RI, Lord SR, Ehrlich F, Janji N, Rahman A. Predictors of falling in elderly hospital patients. Archives of Gerontology and Geriatrics. May 2004.

Ziden L, Wenestam CG, Hansson-Scherman M. A life-breaking event: Early experiences of the consequences of a hip fracture for elderly people. Clinical Rehabilitation. September 2008.

Availability of Data Sources and Results
Data Sources

DAD

Available Data Years

Type of Year:
Fiscal
First Available Year:
2011
Last Available Year:
2015

Geographic Coverage

All provinces/territories except Quebec

Reporting Level/Disaggregation

National, Province/Territory, Region, Facility, Peer Group

Result Updates
Update Frequency

Every year

Indicator Results

Web Tool:
CIHI Health Indicators
URL: https://www.cihi.ca/en/cihi-health-indicators

Updates

Starting in 2012–2013, the following inclusion/exclusion criteria updates were made:

– Added numerator exclusion of T81.88 coded as type 2
– Removed exclusion criteria for invalid or non-unique Health Card Number, invalid admission date or time, invalid discharge date or time, and records with Canada (CA) as the province/territory issuing the Health Card Number

Quality Statement
Caveats and Limitations

Quebec data is not included in this indicator; therefore, pan-Canadian comparisons cannot be made.

Trending Issues

For the 2013 release, the upper age limit of 105 years was removed for calculation of the 2011–2012 data.

Comments

Not applicable