Age and Ageing 2013; 42: 816

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Letter to the Editor Re: Trends in hip fracture incidence and mortality in Chinese population from Hong Kong 2001–09

Hospitals that achieve these indicators will be incentivised and adequately reimbursed for the cost of care provided. Hence, despite an increasing elderly population, our hip fracture incidence has not risen and there has been a drop in 30-day and 365-day mortality.

Conflicts of interest 2008

2009

2010

2011

........................................ ≥65 years old (nearest 100 population estimate) Hip fracture (patients) Incidence/1,000 patient population

134,700 137,900 141,300 142,400 646 4.8

745 5.4

733 5.2

699 4.9

Hip fracture mortality has decreased over this period. Third-day mortality has decreased from 11.2 to 8.7% (mean, SD; 9.2, 1.5) and 1-year mortality (2008–10 data) decreased from 30.7 to 26.8% (mean, SD; 28.9, 2.0). There have been a number of national policies which have helped drive this reduction in mortality which includes the introduction of the Blue Book [3] and national guidance [4]. The Blue Book is an evidence-based clinical guide which describes the ideal model of care for this group of patients. A much lauded initiative is the collaboration between the surgeon and an orthogeriatrician in delivering this model of care. Perhaps the most notable effect is the introduction of the best practice tariff (BPT) for hip fractures, where hospitals are financially incentivised for delivering high-quality care based on principles outlined in the Blue Book. The BPT indicators are

816

None declared. TERENCE ONG, OPINDER SAHOTA, LINDSEY MARSHALL, CHRIS G. MORAN Queens Medical Centre, Nottingham, UK [email protected]

References 1. Chau P, Wong M, Lee A et al. Trends in hip fracture incidence and mortality in Chinese population. Age Ageing 2013; 42: 229–33. 2. Nottinghamshire County Council. Economic data. 2013. Available at: http://www.nottinghamshire.gov.uk/living/business/ economicdata/? (18 March 2013, date last accessed). 3. The care of patients with fragility fracture. 2007. Available at: http://www.nhfd.co.uk/003/hipfracturer.nsf/luMenuDefinitions/ FCEF9FCB98A1B8EB802579C900553996/$file/Blue_Book. pdf ?OpenElement. 4. National Institute for Health and Clinical Excellence. The Management of Hip Fracture in Adults. CG124. London: National Institute for Health and Clinical Excellence, 2009. doi: 10.1093/ageing/aft149

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SIR—We read with interest the article by Chau et al. [1] on the trends in hip fracture incidence and mortality in Hong Kong. It is encouraging to know that the incidence of hip fracture which carries significant morbidity and mortality is on a downward trend in their cohort although post-fracture mortality has not changed. In Nottinghamshire ( population of 780,000, 1.2% of the UK population), the hip fracture incidence from 2008 to 2011 in the over 65 age group has remained much the same. This is against a backdrop of a rising elderly population locally based on population estimates and data from a 2011 census [2].

• time from diagnosis or presentation to an emergency department to operation within 36 h; • admitted under the joint care of a consultant orthopaedic surgeon and consultant orthogeriatrician using an assessment protocol agreed by the orthopaedic team, geriatric medicine and anaesthetic team; • assessment by a geriatrician during the peri-operative stage, i.e. within 72 h of admission; • post-operative geriatrician directed care coordinating the multi-disciplinary rehabilitation team and fractures prevention assessments.

Re: trends in hip fracture incidence and mortality in Chinese population from Hong Kong 2001-09.

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