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## Complete Summary

#### TITLE

Hip fracture: risk adjusted rate of in-hospital hip fracture among acute
care inpatients aged 65 years and over, per 1,000 discharges.

#### SOURCE(S)

Canadian Institute for Health Information (CIHI). Health indicators
2007: definitions, data sources and rationale. Ottawa (ON): Canadian
Institute for Health Information (CIHI); 2007 May. 37 p.

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Outcome

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the risk-adjusted rate of in-hospital hip
fracture among acute care inpatients age 65 years and over, per 1,000
discharges.

#### RATIONALE

Proposed by the Agency for Healthcare Research and Quality (AHRQ) and
based on the Complications Screening Program, this indicator represents
a potentially preventable complication resulting from an inpatient stay
in acute care facility. Variation in the rates may be attributed to
numerous factors, including hospital processes, environmental safety,
and availability of nursing care. High rates may prompt investigation of
potential quality of care deficiencies.

#### PRIMARY CLINICAL COMPONENT

In-hospital hip fracture rate

#### DENOMINATOR DESCRIPTION

Total number of discharges among inpatients age 65 years and older (see
the related \"Denominator Inclusions/Exclusions\" field in the Complete
Summary)

#### NUMERATOR DESCRIPTION

Total number of discharges coded with in-hospital hip fracture for age
65 and over

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A formal consensus procedure involving experts in relevant clinical,
    methodological, and organizational sciences

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Use of this measure to improve performance\
Variation in quality for the performance measured

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

Canadian Institute for Health Information (CIHI). Health indicators
2007. Ottawa (ON): Canadian Institute for Health Information (CIHI);
2007. 87 p.

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Federal health policymaking\
Internal quality improvement\
National reporting

### Application of Measure in its Current Use

#### CARE SETTING

Hospitals

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Measure is not provider specific

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Regional

#### TARGET POPULATION AGE

Age 65 years and older

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Nearly 1 in 1,000 seniors admitted to hospital in Canada fracture a hip
during their stay.

#### EVIDENCE FOR INCIDENCE/PREVALENCE

Canadian Institute for Health Information (CIHI). Health indicators
2007. Ottawa (ON): Canadian Institute for Health Information (CIHI);
2007. 87 p.

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

An Ontario study published in 2001 estimated that direct health care
costs for treating a hip fracture, in the hospital and afterwards,
average about \$27,000 over a year.

#### EVIDENCE FOR COSTS

Canadian Institute for Health Information (CIHI). Health indicators
2007. Ottawa (ON): Canadian Institute for Health Information (CIHI);
2007. 87 p.

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Safety

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

Total number of discharges among inpatients age 65 years and older

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Total number of discharges among inpatients age 65 years and older

**Exclusions**\
Fracture of bone following insertion of orthopaedic implant, joint
prosthesis, or bone plate (International Statistical Classification of
Diseases and Related Health Problems, 10th Revision, Canadian version
\[ICD-10-CA\] code M96.6) and in-hospital hip fracture coded in
conjunction with an external cause of injury code of \"misadventure
during surgical or medical care\" have been excluded because these
events do not reflect patient safety in the context with which it is
currently understood.

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Institutionalization

#### DENOMINATOR TIME WINDOW

Time window brackets index event

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Total number of discharges coded with in-hospital hip fracture for age
65 and older

**Exclusions**\
Unspecified

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Institutionalization

#### DATA SOURCE

Administrative data

#### LEVEL OF DETERMINATION OF QUALITY

Not Individual Case

#### OUTCOME TYPE

Adverse Outcome

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a lower score

#### ALLOWANCE FOR PATIENT FACTORS

Risk adjustment devised specifically for this measure/condition

#### DESCRIPTION OF ALLOWANCE FOR PATIENT FACTORS

A logistic regression model is fitted with age, sex, whether a surgical
procedure was provided, and the following preadmission comorbid
conditions: cancer, seizure, syncope, stroke, coma, cardiac arrest,
anoxic brain injury, poisoning, delirium and other psychosis, trauma and
musculoskeletal/connective tissue disorder (MCC-8) as independent
variables. Coefficients derived from the logistic model are used to
calculate the probability of in-hospital hip fracture for each case
(episode). The expected number of in-hospital hip fractures of a region
is the sum of these case probabilities for that region. The risk
adjusted in-hospital hip fracture rate (RAR) is calculated by dividing
the observed number of in-hospital hip fractures of each region by the
expected number of in-hospital hip fractures of the region and
multiplying by the Canadian average rate. A 95 percent confidence
interval for the RAR is also calculated and the method used to calculate
confidence intervals is available upon request.

#### STANDARD OF COMPARISON

External comparison at a point in time\
External comparison of time trends\
Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

In-hospital hip fracture rate.

#### MEASURE COLLECTION

[Health Indicators
2007](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1898&doc=11544)

#### DEVELOPER

Canadian Institute for Health Information

#### FUNDING SOURCE(S)

Canadian Government

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

*Employees*: Canadian Institute for Health Information (CIHI) Health
Indicator Team

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

None

#### ADAPTATION

Measure was adapted from another source.

#### PARENT MEASURE

Postoperative Hip Fracture (PSI 8) \[Agency for Healthcare Research and
Quality (AHRQ)\]

#### RELEASE DATE

2006 Jun

#### REVISION DATE

2007 May

#### MEASURE STATUS

**Please note**: This measure has been updated. The National Quality
Measures Clearinghouse is working to update this summary.

#### SOURCE(S)

Canadian Institute for Health Information (CIHI). Health indicators
2007: definitions, data sources and rationale. Ottawa (ON): Canadian
Institute for Health Information (CIHI); 2007 May. 37 p.

#### MEASURE AVAILABILITY

The individual measure, \"In-Hospital Hip Fracture Rate,\" is published
in \"Health Indicators 2007: Definitions, Data Sources and Rationale.\"
An update of this document is available in Portable Document Format
(PDF) from the [Canadian Institute for Health Information (CIHI) Web
site](http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=indicators_def_toc_08_e).

For more information, contact CIHI at, 495 Richmond Road, Suite 600,
Ottawa, Ontario, K2A 4H6, Canada; Phone: 613-241-7860; Fax:
613-241-8120; E-mail: <indicators@cihi.ca>; Web site:
<http://secure.cihi.ca/cihiweb/>.

#### COMPANION DOCUMENTS

The following is available:

-   Canadian Institute for Health Information (CIHI). Health
    indicators 2007. Ottawa (ON): Canadian Institute for Health
    Information (CIHI); 2007. 87 p. This document is available in
    Portable Document Format (PDF) from the [Canadian Institute for
    Health Information (CIHI) Web
    site](http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=PG_770_E&cw_topic=770&cw_rel=AR_152_E#full).

-   Canadian Institute for Health Information (CIHI). ICD-9/CCP,
    ICD-9-CM and ICD-10-CA/CCI codes for health indicators 2007. Ottawa
    (ON): Canadian Institute for Health Information (CIHI); 2007.
    various p. This document is available from the [CIHI Web
    site](http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=tech_notes_e).

#### NQMC STATUS

This NQMC summary was completed by ECRI Institute on October 23, 2007.
The information was verified by the measure developer on November 28,
2007.

#### COPYRIGHT STATEMENT

This NQMC summary is based on the original measure, which is subject to
the measure developer\'s copyright restrictions. Use of Canadian
Institute for Health Information\'s (CIHI) quality measure for research,
private study, education, or other non-commercial purposes is permitted
where full credit is given to CIHI as author and owner of the quality
measure. Any use that is wholly or partly commercial in nature requires
CIHI\'s express written permission.

Questions and inquiries may be directed to CIHI at, 495 Richmond Road,
Suite 600, Ottawa, Ontario, K2A 4H6, Canada; Phone: 613-241-7860; Fax:
613-241-8120.

### Disclaimer

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008