Learning From England's Best Practice Tariff: Process Measure Pay-for-Performance Can Improve Hip Fracture Outcomes

Zogg, Cheryl K, Metcalfe, David, Judge, Andrew, Perry, Daniel C ORCID: 0000-0001-8420-8252, Costa, Matthew L, Gabbe, Belinda J, Schoenfeld, Andrew J, Davis, Kimberly A, Cooper, Zara and Lichtman, Judith H (2022) Learning From England's Best Practice Tariff: Process Measure Pay-for-Performance Can Improve Hip Fracture Outcomes. ANNALS OF SURGERY, 275 (3). pp. 506-514.

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Official URL: http://dx.doi.org/10.1097/sla.0000000000004305

Abstract

<h4>Objective</h4>The objective of this study was to evaluate England's Best Practice Tariff (BPT) and consider potential implications for Medicare patients should the US adopt a similar plan.<h4>Summary background data</h4>Since the beginning of the Affordable Care Act, Medicare has renewed efforts to improve the outcomes of older adults through introduction of an expanding set of alternative-payment models. Among trauma patients, recommended arrangements met with mixed success given concerns about the heterogeneous nature of trauma patients and resulting outcome variation. A novel approach taken for hip fractures in England could offer a viable alternative.<h4>Methods</h4>Linear regression, interrupted time-series, difference-in-difference, and counterfactual models of 2000 to 2016 Medicare (US), HES-APC (England) death certificate-linked claims (≥65 years) were used to: track US hip fracture trends, look at changes in English hip fracture trends before-and-after BPT implementation, compare changes in US-versus-English mortality, and estimate total/theoretical lives saved.<h4>Results</h4>A total of 806,036 English and 3,221,109 US hospitalizations were included. After BPT implementation, England's 30-day mortality decreased by 2.6 percentage-points (95%CI: 1.7-3.5) from a baseline of 9.9% (relative reduction 26.3%). 90- and 365-day mortality decreased by 5.6 and 5.4 percentage-points. 30/90/365-day readmissions also declined with a concurrent shortening of hospital length-of-stay. From 2000 to 2016, US outcomes were stagnant (P > 0.05), resulting in an inversion of the countries' mortality and >38,000 potential annual US lives saved.<h4>Conclusions</h4>Process measure pay-for-performance led to significant improvements in English hip fracture outcomes. As efforts to improve US older adult health continue to increase, there are important lessons to be learned from a successful initiative like the BPT.

Item Type:	Article
Uncontrolled Keywords:	hip fracture, Medicare, mortality, older adult, pay-for-performance, process measure, trauma
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	02 Feb 2023 09:35
Last Modified:	02 Feb 2023 09:35
DOI:	10.1097/SLA.0000000000004305
Open Access URL:	https://research-information.bris.ac.uk/en/publica...
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3168099