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Emergency hospital admissions for hip fracture in people aged 60 and over

Independently assured by the Information Governance Board (IGB)


Published by
NHS Digital
Assurance Date
02 Dec 2013
Reporting level
CCG and National
Reporting period
Annual
Review date
02 Dec 2016
Based on data from
Hospital Episodes Statistics (HES), National Health Application and Infrastructure Services (NHAIS), Office for National Statistics (ONS) mid-year population estimates
Geographic Coverage
England

Purpose

Hip fracture is a major public health issue. It is the most common reason for admission to an orthopaedic trauma ward and predominantly affects older people. Incidence is growing with the increase in the ageing population. About 70,000 to 75,000 hip fractures (proximal femoral fractures) occur annually in the UK, with a cost, including medical and social care, amounting to around £2 billion a year.

It is expected that Clinical Commissioning Groups (CCGs) will use this to identify how improvements in care and the desired reduction of emergency hip fracture admissions will be delivered.

Definition

The indicator is a rate per 100,000 registered patients directly standardised by age and sex using the England population for the standard population. The indicator is published with 95% confidence intervals recognising the existence of natural variation among the Clinical Commissioning Group (CCG) populations.

The indicator is limited to those aged 60 years and over, aligning to the Best Practice Tariff (BPT) for hip fracture care and the National Hip Fracture Database (NHFD). Selecting this age range puts the focus on people with osteoporosis and those who are more at risk of falling, moving it away from other causes such as falls from height or road traffic accidents.

The indicator measures the rate of emergency admissions for hip fracture, as opposed to the rate of people admitted as an emergency with hip fracture. If a person fractures a hip more than once in a year, they would appear multiple times in the numerator.

How this indicator is calculated

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Hospital Episodes Statistics (HES), National Health Application and Infrastructure Services (NHAIS), Office for National Statistics (ONS) mid-year population estimates.

The underlying HES data is held by NHS Digital and made available to customers via several mechanisms depending on their requirements. These include the publication of aggregated output, an extract service that covers both bespoke and routine extracts and direct access via an interrogation tool to the underlying data for certain customers.

The underlying data required for the construction of the indicator are available on a monthly basis around 4 to 5 months after the start of the month in which the attendance took place. The full year annual data refresh occurs around 8 months after the financial year end.

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The number of admission spell records where the first episode contains a primary diagnosis of hip fracture in people aged 60 and over.

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Clinical Commissioning Group (CCG) level count of people registered with the constituent GP Practices.

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This indicator is calculated as a rate directly standardised by age and sex per 100,000 patients.

The standard population used for the direct method is the England population in appropriate ONS mid-year population estimates. The age groups used are: 0 to 19, 20 to 24, 25 to 29, 30 to 34, 35 to 39, 40 to 44, 45 to 49, 50 to 54, 55 to 59, 60 to 64, 65 to 69, 70 to 74, 75+.

95% confidence intervals are calculated using Dobson's and Byar's methods. Byar’s method is recommended for larger counts whereas for smaller numerators (less than 389) a more exact method based on the Poisson distribution (Dobson’s method) is used. Further details on the calculations used can be found in the techincal specifcation.

Caveats

A patient could fracture both hips or fracture a hip more than once in a year. In such a case they would appear twice in the numerator data.

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