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2015 data
Introduction from Atlas to Action
This workbook is designed to help connect data from the Health Quality amp Safety Commissions Atlas of Healthcare Variation falls domain with local action It has been updated with data from 2015
We recommend you discuss the Atlas data at all levels of clinical governance ndash from the DHB falls prevention committee to the Board and in your health of older persons network
From AtlasKnow your data
This workbook is designed to focus your attention on the data in eight indicators looking at the incidence of fall-related injuries and aspects of treatment in people aged 50 and older The Workbook is provided in Word format so it can be customised for your DHB area
to ActionWhats your plan
The Atlas data provide a baseline for your planning and improvement projects The Commissionrsquos Reducing Harm from Falls programmersquos expert advisory group has recommended an integrated approach to falls in older people with 10 Priorities identified for attention
The Atlas data at a district level promote consideration of older people as a population group which ranges from those who are generally healthy and active to those who are very frail or debilitated
Broadly speaking an integrated approach to meet the needs of this diverse group encompasses
primary prevention of falls in older people preventing falls in the first place for example through promotion of general physical activity and exercise programmes to improve balance and strength or assessment of bone health from age 50 for early prevention and treatment of osteoporosis and ensuring safe civic and home environments
secondary prevention for those who have had a fall with or without injury ndash here special attention might be given to the age group 85 and older as those who are most frail most likely to fall and most likely to have a fall-related injury ndash nationally 25 percent have at least one ACC claim for a fall each year
Wed like to acknowledge the work done by the members of the expert advisory group convened by the Commission for the specific purpose of developing the falls domain
We hope you find the Workbook supports your teams discussion of how to build on the work you are already doing and planning to prevent falls and reduce harm from falls
Thank you
Reducing Harm from Falls expert advisory group and programme team
Health Quality Evaluation team
Whats in this Workbook
How to use the Workbook 1
From Atlas to Action key resources 2
Highlights from the evidence what works 3
Key indicator summary for our DHB area and implications 4
Worksheets for indicators in the Atlas of Healthcare Variation falls domain
1 People 50+ with one or more ACC claim for a fall 5
2 People 50+ with one or more hospital admissions due to a fall 6
3 People 50+ admitted for more than one day due to a fall 7
4 Average bed-days for people 50+ admitted with a fall (DHB of domicile) 8
5 Hip fracture 50+ due to a fall (DHB of domicile) 9
6 Percent hip fracture 50+ operated on the same or next day of admission (DHB of service)
10
7 Percent bisphosphonate on discharge following hip fracture (DHB of service) 11
8 Percent vitamin D on discharge following hip fracture (DHB of service) 12
OTHER RESOURCES
Tutorial using the bar chart to determine statistical significance 13
Understanding variation
The goal of the falls domain was to explore any areas of wide variation between DHBs and identify possible areas for local quality improvement In particular we are interested in identifying lsquounwarrantedrsquo variation that is variation in health service use that cannot be explained by differences in patient illness or preferences
Resources on the health quality evaluation webpages are
Variation in medical practice literature review and discussion
Addressing unwarranted variation literature review on methods for influencing practice
Variation and improving services analysing and interpreting variation
Selected references1 Rubenstein LZ 2006 Falls in older people epidemiology risk factors and strategies for prevention
Age and Ageing 35ndashS2ii37ndashii412 Gillespie LD Robertson MC Gillespie WJ et al 2012 Interventions for preventing falls in older people
living in the community Cochrane Database of Systematic Reviews (9) CD0071463 Cameron ID Gillespie LD Robertson MC et al 2012 Interventions for preventing falls in older people
in care facilities and hospitals Cochrane Database of Systematic Reviews (12) CD0054654 Carande-Kulis V Stevens JA Florence CS et al 2015 A costndashbenefit analysis of three older adult fall
prevention interventions Journal of Safety Research 52 65ndash705 Gallagher JC Melton LJ Riggs BL et al 1980 Epidemiology of fractures of the proximal femur in
Rochester Minnesota Clinical Orthopaedics and Related Research 150 163ndash716 Port L Center J Briffa NK et al 2003 Osteoporotic fracture missed opportunity for intervention
Osteoporosis International 14(9) 780ndash4
How to use the Workbook
We recommended that data from the Atlas of Healthcare Variation falls domain are reviewed at all levels of clinical governance
The workbook is designed to support structured discussion on each of the eight indicators looking at the incidence of fall-related injuries and aspects of treatment in people aged 50 and older
It may be appropriate that your DHB areas data is entered into the worksheets as a first step (the workbook is provided in a Word format to allow you to customise the content)
WORKBOOK FEATURES
Highlights from the evidence for preventing falls and reducing harm from falls ndash key points relevant for community-wide planning to inform your discussion of Atlas data in the worksheet for each indicator
Worksheets for each indicator suggest key questions for discussion directing attention to immediate gains with high-risk
groups and longer-term gains in a population health approach allow you to record Atlas data in a breakdown of ethnicity age group and gender
add figures or edit text at the grey highlight in some places youll need to calculate percentage with reference to the preceding
figures suggest comparisons using the bar chart with the national mean and a similar DHB area
We recommend you enter your DHB areas data in the worksheets ahead of discussion and work through all questions before summarising your discussion in the key indicator summary (page 4)
Key indicator summary ndash complete this page to summarise your discussion of data from the worksheets These three indicators help focus on planning implications for the incidence of
fall-related injuries treated in the community hospital admissions for fall-related injuries hip fracture due to a fall
RESOURCES 10 Topics in reducing harm from falls and other resources developed in the national falls
programme are matched to the issues and questions raised by the Atlas indicators Theres a tutorial at the end of this workbook on using the bar chart to determine whether or
not differences against the national mean and between DHBs are statistically significant
See also Resources and activities on the Commissions reducing harm from falls web pages
FEEDBACKPlease provide feedback on the Workbook and your experience of using it to infohqscgovtnz
Wed particularly like to hear about any questions prompted by the data that havent been mentioned in the Workbook We may include your insights in any future revisions
Workbook From Atlas to Action (2015 data) published March 2017 page 1
From Atlas to Action key resources
Atlas of Healthcare Variation falls domain The falls domain was originally developed by an expert advisory group (EAG) convened by the Health Quality amp Safety Commission in 2013 In 2016 it was updated with 2014 data and now in April 2017 it has been updated with 2015 data The EAG includes members of the EAG for the national falls programme Reducing Harm from Falls The falls domain gives clinicians patients and providers an overview of the prevalence of falls in people aged 50 and older including those treated in the community and in hospital
Find the falls Atlas domain here
The falls Atlas domain presents data on eight indicators by DHB areas in an interactive map tables and bar graph Read the relevant commentary online while using the worksheet for each indicator
WebinarFrom Atlas to Action ndash How to use the Atlas of Healthcare falls domainwith Dr Shankar Sankaran from Counties Manukau Health falls Clinical Lead Sandy Blake and theHealth Quality amp Safety Commissionrsquos Catherine Gerard
The webinar from Tuesday 14 April 2015 is available here and it is still relevant to help users with the April 2017 update
Patient perspective this story could have been differentKeep the focus on the userrsquos perspective to plan and provide integrated servicesFind it here
These short summaries of current evidence and best practice cover core issues in falls prevention for older people and introduce the resources and videos developed in the national programme Links to the relevant Topic are given on the worksheet for each Atlas indicator to help inform your reflection and discussion
Workbook From Atlas to Action (2015 data) published March 2017 page 2
Highlights from the evidence what works
A summary of findings in the falls Atlas data for 2015 confirms that for people aged 65 and older falls are a major cause of injury
110300 had at least one ACC claim in 2015 due to a fall in other words 300 ACC claims were accepted every day
20580 were admitted to hospital after a fall
3404 of these admissions were for a fall-related hip fracture
Among those aged 85 and older 26 percent had one or more ACC claim and of these 33 percent were admitted to hospital for more than one day as a result of their fall with an average length of stay of 14 days
However falls are not an inevitable part of ageing ndash there is strong evidence for preventing falls and reducing harm from falls Effective interventions ndash when implemented ndash reduce the impact of falls and reduce costs at individual system and population levels
The expert advisory group for the national falls programme asks you to give attention to these highlights from the evidence as to what works
Exercise to improve balance and strength is cost-effective
A costndashbenefit analysis published in early 2015 reviewed three falls prevention programmes for older people on the basis that they demonstrated a high level of effectiveness in randomised controlled trials had been implemented in community settings and were appropriate for people with differing levels of falls risk The programmes were the Otago Exercise Programme for people aged 65 and older or 80 and older Tai Chi Moving for Better Balance and Stepping On Analysis of the return on investment for these programmes showed that the benefits not only covered the implementation costs but also exceeded the expected direct medical costs4 ndash in other words these programmes prevented falls and provided a substantial return on investment
Home safety assessment and modification is effective for those at higher risk of falling
The 2012 Cochrane review on preventing falls in older people living in the community presents strong evidence from randomised controlled trials in the older age group that home safety assessment and modification programmes are effective in reducing falls particularly those at a higher risk of falling and when the programme is delivered by an occupational therapist
Multifactorial risk assessment and individualised interventions
Health professionals can ask older people about falls and injuries and work with them and their families to reduce the risk of falls and related injuries Although there are common risk factors in
the age group every older person is different and needs an individualised plan of care that addresses their particular risk factors through appropriate treatments and referrals
Short length of stay in acute care settings makes this approach more challenging but multifactorial interventions are effective for reducing the number of falls in older people living in the community
Workbook From Atlas to Action (2015 data) published March 2017 page 3
Key indicator summary for our DHB area and implications
Summary of data and responses from worksheets to inform planning
INDICATOR
1 ACC claims for fall-related injuries Nationally 217000 people aged 50 and older had an ACC claim for a fall-related injury accepted in 2015 People aged 85 and over were twice as likely to have an ACC claim for a fall-related injury and were 15 times more likely to be admitted to hospital as a result
Falls Atlas Indicator 1 key points for action from the data and questions
INDICATOR
3 Hospital admissions for fall-related injuries Nationally 20100 people aged 50 and older were admitted to hospital for more than one day due to a fall-related injury in 2015
Falls Atlas Indicator 3 key points for action from the data and questions
INDICATOR
5 Hip fracture due to a fallNationally 3600 people aged 50 and older had a fall-related hip fracture in 2015
Falls Atlas Indicator 5 key points for action from the data and questions
Implications from the data for our DHB area
Given the ageing population and the points noted above implications for planning and providing an integrated approach in our DHB area are as follows describe
Workbook From Atlas to Action (2015 data) published March 2017 page 4
IND
ICA
TOR
Worksheet People 50+ with one or more ACC claim for a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ with one or more ACC claims
Nationally 26 percent of those aged 85 and older have at least one ACC claim for a fall each year What is the data in the age group table below telling us
Not all fall-related injuries are captured in this data set (ie not reported by patients not medically treated or not claimed for or more than one claim) What assumptions can we make about the rate of falls with injury What can we do to elicit better falls histories
Given the high incidence of falls with injury what is being done community-wide to reduce falls in the frail elderly Are there established programmes and referral pathways
What screening and interventions are undertaken routinely to reduce injury related to falling eg assessment of bone health for detection and treatment of osteoporosis
Our data breakdown and comparisons Compared to the national mean of 142 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher
Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 967Pacific 1037Asian 861All other ethnicities 1543
By age group in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 12565ndash74 years 13575ndash84 years 17985+ years 264
By gender in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 1565Male 1257
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 5
1
Workbook From Atlas to Action (2015 data) published March 2017 page 6
IND
ICA
TOR
People 50+ with one or more hospital admissions due to a fall
Indicator 3 (admissions for more than one day) has been selected for attention in this Workbook as a useful subset of all hospital admissions Indicator 2 includes admissions to emergency departments which may be influenced by factors such as availability of or access to after-hours primary care
Workbook From Atlas to Action (2015 data) published March 2017 page 7
2
IND
ICA
TOR
Worksheet People 50+ admitted for more than one day due to a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ admitted for more than one day due to a fall
This indicator only looks at one fall-related admission per person in a year Do we know how many people had more than one admission for a fall-related injury in a year
Older people admitted due to a fall are by definition at risk of falling and should have their risk factors assessed and addressed in an individualised care plan Is this reflected in the report on our quality and safety markers for falls
Do we know how well we addressed these patients risk factors ndash either as an inpatient or follow-up with GP andor other services For instance medicine use could be reviewed in hospital whereas optimising an older persons vision may be a post-discharge referral
Our data breakdown and comparisons Compared to the national mean of 131 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 76Pacific 79Asian 56All other ethnicities 147
By age group in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 4165ndash74 years 9475ndash84 years 2985+ years 872
By gender in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 156Male 104
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 8
3
Workbook From Atlas to Action (2015 data) published March 2017 page 9
IND
ICA
TOR Worksheet Average bed-days for people 50+ admitted with a fall (DHB of
domicile)
Our data what questions should we ask
In 2015 in our DHB area the average bed-days were number for people aged 50 and older admitted in relation to a fall
Patients admitted with a fall are at risk of further falls as an inpatient (and after discharge) ndash what processes are in place for assessing risk of falling and implementing individualised interventions
What measures are in place to ensure a safe environment and safe care for these and all inpatients Do we audit the safety of the environment in relation to falls
Does use of interim care schemes explain any of the observed variation
How much variation can be explained by severity of injury or frailty
Our data breakdown and comparisons Compared to the national mean of 103 bed-days our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Ethnicity (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Māori 67Pacific 76Asian 84All other ethnicities 106
By age group in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Age group (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
50ndash64 years 4565ndash74 years 875ndash84 years 11685+ years 14
By gender in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Gender (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Female 109Male 92
RESOURCES
Topic 4 Safe environment and safe care essential in preventing falls pdfApril audit How safe is the care environment today Word doc
Workbook From Atlas to Action (2015 data) published March 2017 page 10
4
Workbook From Atlas to Action (2015 data) published March 2017 page 11
IND
ICA
TOR
Worksheet Hip fracture 50+ due to a fall (DHB of domicile)
Our data what questions should we ask
In 2015 in our DHB area hip fractures related to a fall for people aged 50 and older were number Although those in the age group 85 and older make up only 5 percent of the total population nationally in 2015 they represented half of all hip fractures in those aged 50 and older
At least half of the people who break their hip have suffered a prior fragility fracture23 signalling the need for multifactorial interventions directed to reducing their risk of falling and reducing their risk of injury eg treating osteoporosis
What additional data do we have to answer these questions
How many hip fracture patients were previously admitted for a fall-related injury How many have had a previous fragility fracture or hip fracture How many were referred to a Fracture Liaison Service (or equivalent follow-up)
How well is the Fracture Liaison Service integrated with the DHB falls prevention programme
Our data breakdown and comparisons Compared to the national mean of 23 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By age group in our DHB area in 2015 fall-related hip fractures for people 50+ were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 0265ndash74 years 1175ndash84 years 5585+ years 231
By gender in our DHB area in 2015 fall-related hip fractures for people 50+ were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 31Male 15
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 12
5
IND
ICA
TOR Worksheet Percent hip fracture 50+ operated on the same or next day of
admission (DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of hip fractures related to a fall for people aged 50 and older were operated on the day of admission or the next day
The Australian and New Zealand Guideline for Hip Fracture Care recommends that surgery is carried out within 48 hours ie the same or next day following hip fracture
When interpreting this indicator it is important to remember there are a number of reasons why surgery might be delayed such as medical instability need for further investigation or resource constraints such as theatre availability
Looking at local data what are the most common reasons for surgery to be delayed for more than two days
To what extent can delayed surgery be explained by demands on acute theatre resources
What other factors are causing delay to surgery in our DHB Is there a fast-track pathway in place for acute hip fracture If not what are the barriers to
providing one
Our data breakdown and comparisons The percentage in our DHB area is what Compared to the national mean of 764 percent this
is statistically significantly lowerno differentsignificantly higher Compared to what percent in name a similar DHB area our percent is statistically significantly
lowerno differentsignificantly higher
By year 2013-15 in our DHB area percentage and count of hip fractures operated on the day of admission or the next day were
Year National mean Our DHB areaPercentage Count Percentage
2013 7162014 7442015 764
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 13
6
IND
ICA
TOR Worksheet Percent bisphosphonate on discharge following hip fracture
(DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensed a bisphosphonate within six months of discharge from a hospital admission with a hip fracture
A review of bone health is recommended following a hip fracture this includes considering the use of bisphosphonatesa Bisphosphonates are used to reduce bone density loss and are indicated for the prevention and treatment of osteoporosis There is also evidence that bisphosphonates can reduce the risk of osteoporotic fractures however they may not be appropriate for patients with renal failure or a life expectancy of less than two years
Bisphosphonates should be used in conjunction with other individualised falls prevention interventions such as exercise to improve balance and strength and home safety assessment and modifications
Do DHBs with orthogeriatric services andor closely linked Fracture Liaison Services have higher rates of prescribing than those who donrsquot have these services
To what extent do clinical factors such as renal failure or life expectancy judgement explain the rate of bisphosphonate use
Our data breakdown and comparisons Compared to the national mean of 212 percent what percent is statistically significantly
lowerno differentsignificantly higher Compared to the rate of what percent in name a similar DHB area our percent is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentage and count of bisphosphonate dispensing were
Year National mean Our DHB areaPercent Count Percent
2013 2862014 2092015 212
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfBoneCare 2020A systematic approach to hip fracture care and prevention for New Zealand published by Osteoporosis New ZealandStrategies to improve hip fracture prevention and care pdf ndash summarises Bone Care 2020 and provides a four-step check for your local review
a
Workbook From Atlas to Action (2015 data) published March 2017 page 14
7
IND
ICA
TOR Worksheet Percent vitamin D on discharge for hip fracture (DHB of
service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensedb vitamin D within six months of discharge from a hospital admission with a hip fracture
Because vitamin D is essential for bone health and muscle function assessment of risk of vitamin D deficiency is recommended for all older people Health professionals prescribing vitamin D supplements assess the individual and take into account any contraindications
The Atlas shows wide variations between DHBs in the use of vitamin D following hip fracture
Why are some DHBs consistently lower or higher than the national mean How do similar DHBs compare What might the ideal rate of vitamin D use be What might be barriers to increasing rates of prescribing and how might we address
them
Our data breakdown and comparisons Compared to the national mean of 682 percent our rate of what percent is statistically
significantly lowerno differentsignificantly higher Compared to the rate of figure percent in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentages and count of prescribed vitamin D supplement dispensing were
Year National mean Our DHB areaPercentage Count Percentage
2013 7242014 6792015 682
RESOURCESTopic 7 Vitamin D and falls what you need to know pdfThe Ministry of Health and Cancer Societyrsquos Consensus Statement on Vitamin D and Sun Exposure in New Zealand ACC information for prescribers in general practice teams and staff working in residential care
b This data is from the Pharmaceutical Collection which captures prescribed medicines dispensed in a community pharmacy This indicator does not reflect over-the-counter vitamin D supplement use or whether or not medicine was taken The national programme recommends that vitamin D supplements are prescribed by a health practitioner after assessment of the older persons vitamin D status
Workbook From Atlas to Action (2015 data) published March 2017 page 15
8
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
Introduction from Atlas to Action
This workbook is designed to help connect data from the Health Quality amp Safety Commissions Atlas of Healthcare Variation falls domain with local action It has been updated with data from 2015
We recommend you discuss the Atlas data at all levels of clinical governance ndash from the DHB falls prevention committee to the Board and in your health of older persons network
From AtlasKnow your data
This workbook is designed to focus your attention on the data in eight indicators looking at the incidence of fall-related injuries and aspects of treatment in people aged 50 and older The Workbook is provided in Word format so it can be customised for your DHB area
to ActionWhats your plan
The Atlas data provide a baseline for your planning and improvement projects The Commissionrsquos Reducing Harm from Falls programmersquos expert advisory group has recommended an integrated approach to falls in older people with 10 Priorities identified for attention
The Atlas data at a district level promote consideration of older people as a population group which ranges from those who are generally healthy and active to those who are very frail or debilitated
Broadly speaking an integrated approach to meet the needs of this diverse group encompasses
primary prevention of falls in older people preventing falls in the first place for example through promotion of general physical activity and exercise programmes to improve balance and strength or assessment of bone health from age 50 for early prevention and treatment of osteoporosis and ensuring safe civic and home environments
secondary prevention for those who have had a fall with or without injury ndash here special attention might be given to the age group 85 and older as those who are most frail most likely to fall and most likely to have a fall-related injury ndash nationally 25 percent have at least one ACC claim for a fall each year
Wed like to acknowledge the work done by the members of the expert advisory group convened by the Commission for the specific purpose of developing the falls domain
We hope you find the Workbook supports your teams discussion of how to build on the work you are already doing and planning to prevent falls and reduce harm from falls
Thank you
Reducing Harm from Falls expert advisory group and programme team
Health Quality Evaluation team
Whats in this Workbook
How to use the Workbook 1
From Atlas to Action key resources 2
Highlights from the evidence what works 3
Key indicator summary for our DHB area and implications 4
Worksheets for indicators in the Atlas of Healthcare Variation falls domain
1 People 50+ with one or more ACC claim for a fall 5
2 People 50+ with one or more hospital admissions due to a fall 6
3 People 50+ admitted for more than one day due to a fall 7
4 Average bed-days for people 50+ admitted with a fall (DHB of domicile) 8
5 Hip fracture 50+ due to a fall (DHB of domicile) 9
6 Percent hip fracture 50+ operated on the same or next day of admission (DHB of service)
10
7 Percent bisphosphonate on discharge following hip fracture (DHB of service) 11
8 Percent vitamin D on discharge following hip fracture (DHB of service) 12
OTHER RESOURCES
Tutorial using the bar chart to determine statistical significance 13
Understanding variation
The goal of the falls domain was to explore any areas of wide variation between DHBs and identify possible areas for local quality improvement In particular we are interested in identifying lsquounwarrantedrsquo variation that is variation in health service use that cannot be explained by differences in patient illness or preferences
Resources on the health quality evaluation webpages are
Variation in medical practice literature review and discussion
Addressing unwarranted variation literature review on methods for influencing practice
Variation and improving services analysing and interpreting variation
Selected references1 Rubenstein LZ 2006 Falls in older people epidemiology risk factors and strategies for prevention
Age and Ageing 35ndashS2ii37ndashii412 Gillespie LD Robertson MC Gillespie WJ et al 2012 Interventions for preventing falls in older people
living in the community Cochrane Database of Systematic Reviews (9) CD0071463 Cameron ID Gillespie LD Robertson MC et al 2012 Interventions for preventing falls in older people
in care facilities and hospitals Cochrane Database of Systematic Reviews (12) CD0054654 Carande-Kulis V Stevens JA Florence CS et al 2015 A costndashbenefit analysis of three older adult fall
prevention interventions Journal of Safety Research 52 65ndash705 Gallagher JC Melton LJ Riggs BL et al 1980 Epidemiology of fractures of the proximal femur in
Rochester Minnesota Clinical Orthopaedics and Related Research 150 163ndash716 Port L Center J Briffa NK et al 2003 Osteoporotic fracture missed opportunity for intervention
Osteoporosis International 14(9) 780ndash4
How to use the Workbook
We recommended that data from the Atlas of Healthcare Variation falls domain are reviewed at all levels of clinical governance
The workbook is designed to support structured discussion on each of the eight indicators looking at the incidence of fall-related injuries and aspects of treatment in people aged 50 and older
It may be appropriate that your DHB areas data is entered into the worksheets as a first step (the workbook is provided in a Word format to allow you to customise the content)
WORKBOOK FEATURES
Highlights from the evidence for preventing falls and reducing harm from falls ndash key points relevant for community-wide planning to inform your discussion of Atlas data in the worksheet for each indicator
Worksheets for each indicator suggest key questions for discussion directing attention to immediate gains with high-risk
groups and longer-term gains in a population health approach allow you to record Atlas data in a breakdown of ethnicity age group and gender
add figures or edit text at the grey highlight in some places youll need to calculate percentage with reference to the preceding
figures suggest comparisons using the bar chart with the national mean and a similar DHB area
We recommend you enter your DHB areas data in the worksheets ahead of discussion and work through all questions before summarising your discussion in the key indicator summary (page 4)
Key indicator summary ndash complete this page to summarise your discussion of data from the worksheets These three indicators help focus on planning implications for the incidence of
fall-related injuries treated in the community hospital admissions for fall-related injuries hip fracture due to a fall
RESOURCES 10 Topics in reducing harm from falls and other resources developed in the national falls
programme are matched to the issues and questions raised by the Atlas indicators Theres a tutorial at the end of this workbook on using the bar chart to determine whether or
not differences against the national mean and between DHBs are statistically significant
See also Resources and activities on the Commissions reducing harm from falls web pages
FEEDBACKPlease provide feedback on the Workbook and your experience of using it to infohqscgovtnz
Wed particularly like to hear about any questions prompted by the data that havent been mentioned in the Workbook We may include your insights in any future revisions
Workbook From Atlas to Action (2015 data) published March 2017 page 1
From Atlas to Action key resources
Atlas of Healthcare Variation falls domain The falls domain was originally developed by an expert advisory group (EAG) convened by the Health Quality amp Safety Commission in 2013 In 2016 it was updated with 2014 data and now in April 2017 it has been updated with 2015 data The EAG includes members of the EAG for the national falls programme Reducing Harm from Falls The falls domain gives clinicians patients and providers an overview of the prevalence of falls in people aged 50 and older including those treated in the community and in hospital
Find the falls Atlas domain here
The falls Atlas domain presents data on eight indicators by DHB areas in an interactive map tables and bar graph Read the relevant commentary online while using the worksheet for each indicator
WebinarFrom Atlas to Action ndash How to use the Atlas of Healthcare falls domainwith Dr Shankar Sankaran from Counties Manukau Health falls Clinical Lead Sandy Blake and theHealth Quality amp Safety Commissionrsquos Catherine Gerard
The webinar from Tuesday 14 April 2015 is available here and it is still relevant to help users with the April 2017 update
Patient perspective this story could have been differentKeep the focus on the userrsquos perspective to plan and provide integrated servicesFind it here
These short summaries of current evidence and best practice cover core issues in falls prevention for older people and introduce the resources and videos developed in the national programme Links to the relevant Topic are given on the worksheet for each Atlas indicator to help inform your reflection and discussion
Workbook From Atlas to Action (2015 data) published March 2017 page 2
Highlights from the evidence what works
A summary of findings in the falls Atlas data for 2015 confirms that for people aged 65 and older falls are a major cause of injury
110300 had at least one ACC claim in 2015 due to a fall in other words 300 ACC claims were accepted every day
20580 were admitted to hospital after a fall
3404 of these admissions were for a fall-related hip fracture
Among those aged 85 and older 26 percent had one or more ACC claim and of these 33 percent were admitted to hospital for more than one day as a result of their fall with an average length of stay of 14 days
However falls are not an inevitable part of ageing ndash there is strong evidence for preventing falls and reducing harm from falls Effective interventions ndash when implemented ndash reduce the impact of falls and reduce costs at individual system and population levels
The expert advisory group for the national falls programme asks you to give attention to these highlights from the evidence as to what works
Exercise to improve balance and strength is cost-effective
A costndashbenefit analysis published in early 2015 reviewed three falls prevention programmes for older people on the basis that they demonstrated a high level of effectiveness in randomised controlled trials had been implemented in community settings and were appropriate for people with differing levels of falls risk The programmes were the Otago Exercise Programme for people aged 65 and older or 80 and older Tai Chi Moving for Better Balance and Stepping On Analysis of the return on investment for these programmes showed that the benefits not only covered the implementation costs but also exceeded the expected direct medical costs4 ndash in other words these programmes prevented falls and provided a substantial return on investment
Home safety assessment and modification is effective for those at higher risk of falling
The 2012 Cochrane review on preventing falls in older people living in the community presents strong evidence from randomised controlled trials in the older age group that home safety assessment and modification programmes are effective in reducing falls particularly those at a higher risk of falling and when the programme is delivered by an occupational therapist
Multifactorial risk assessment and individualised interventions
Health professionals can ask older people about falls and injuries and work with them and their families to reduce the risk of falls and related injuries Although there are common risk factors in
the age group every older person is different and needs an individualised plan of care that addresses their particular risk factors through appropriate treatments and referrals
Short length of stay in acute care settings makes this approach more challenging but multifactorial interventions are effective for reducing the number of falls in older people living in the community
Workbook From Atlas to Action (2015 data) published March 2017 page 3
Key indicator summary for our DHB area and implications
Summary of data and responses from worksheets to inform planning
INDICATOR
1 ACC claims for fall-related injuries Nationally 217000 people aged 50 and older had an ACC claim for a fall-related injury accepted in 2015 People aged 85 and over were twice as likely to have an ACC claim for a fall-related injury and were 15 times more likely to be admitted to hospital as a result
Falls Atlas Indicator 1 key points for action from the data and questions
INDICATOR
3 Hospital admissions for fall-related injuries Nationally 20100 people aged 50 and older were admitted to hospital for more than one day due to a fall-related injury in 2015
Falls Atlas Indicator 3 key points for action from the data and questions
INDICATOR
5 Hip fracture due to a fallNationally 3600 people aged 50 and older had a fall-related hip fracture in 2015
Falls Atlas Indicator 5 key points for action from the data and questions
Implications from the data for our DHB area
Given the ageing population and the points noted above implications for planning and providing an integrated approach in our DHB area are as follows describe
Workbook From Atlas to Action (2015 data) published March 2017 page 4
IND
ICA
TOR
Worksheet People 50+ with one or more ACC claim for a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ with one or more ACC claims
Nationally 26 percent of those aged 85 and older have at least one ACC claim for a fall each year What is the data in the age group table below telling us
Not all fall-related injuries are captured in this data set (ie not reported by patients not medically treated or not claimed for or more than one claim) What assumptions can we make about the rate of falls with injury What can we do to elicit better falls histories
Given the high incidence of falls with injury what is being done community-wide to reduce falls in the frail elderly Are there established programmes and referral pathways
What screening and interventions are undertaken routinely to reduce injury related to falling eg assessment of bone health for detection and treatment of osteoporosis
Our data breakdown and comparisons Compared to the national mean of 142 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher
Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 967Pacific 1037Asian 861All other ethnicities 1543
By age group in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 12565ndash74 years 13575ndash84 years 17985+ years 264
By gender in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 1565Male 1257
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 5
1
Workbook From Atlas to Action (2015 data) published March 2017 page 6
IND
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People 50+ with one or more hospital admissions due to a fall
Indicator 3 (admissions for more than one day) has been selected for attention in this Workbook as a useful subset of all hospital admissions Indicator 2 includes admissions to emergency departments which may be influenced by factors such as availability of or access to after-hours primary care
Workbook From Atlas to Action (2015 data) published March 2017 page 7
2
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Worksheet People 50+ admitted for more than one day due to a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ admitted for more than one day due to a fall
This indicator only looks at one fall-related admission per person in a year Do we know how many people had more than one admission for a fall-related injury in a year
Older people admitted due to a fall are by definition at risk of falling and should have their risk factors assessed and addressed in an individualised care plan Is this reflected in the report on our quality and safety markers for falls
Do we know how well we addressed these patients risk factors ndash either as an inpatient or follow-up with GP andor other services For instance medicine use could be reviewed in hospital whereas optimising an older persons vision may be a post-discharge referral
Our data breakdown and comparisons Compared to the national mean of 131 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 76Pacific 79Asian 56All other ethnicities 147
By age group in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 4165ndash74 years 9475ndash84 years 2985+ years 872
By gender in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 156Male 104
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 8
3
Workbook From Atlas to Action (2015 data) published March 2017 page 9
IND
ICA
TOR Worksheet Average bed-days for people 50+ admitted with a fall (DHB of
domicile)
Our data what questions should we ask
In 2015 in our DHB area the average bed-days were number for people aged 50 and older admitted in relation to a fall
Patients admitted with a fall are at risk of further falls as an inpatient (and after discharge) ndash what processes are in place for assessing risk of falling and implementing individualised interventions
What measures are in place to ensure a safe environment and safe care for these and all inpatients Do we audit the safety of the environment in relation to falls
Does use of interim care schemes explain any of the observed variation
How much variation can be explained by severity of injury or frailty
Our data breakdown and comparisons Compared to the national mean of 103 bed-days our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Ethnicity (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Māori 67Pacific 76Asian 84All other ethnicities 106
By age group in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Age group (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
50ndash64 years 4565ndash74 years 875ndash84 years 11685+ years 14
By gender in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Gender (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Female 109Male 92
RESOURCES
Topic 4 Safe environment and safe care essential in preventing falls pdfApril audit How safe is the care environment today Word doc
Workbook From Atlas to Action (2015 data) published March 2017 page 10
4
Workbook From Atlas to Action (2015 data) published March 2017 page 11
IND
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Worksheet Hip fracture 50+ due to a fall (DHB of domicile)
Our data what questions should we ask
In 2015 in our DHB area hip fractures related to a fall for people aged 50 and older were number Although those in the age group 85 and older make up only 5 percent of the total population nationally in 2015 they represented half of all hip fractures in those aged 50 and older
At least half of the people who break their hip have suffered a prior fragility fracture23 signalling the need for multifactorial interventions directed to reducing their risk of falling and reducing their risk of injury eg treating osteoporosis
What additional data do we have to answer these questions
How many hip fracture patients were previously admitted for a fall-related injury How many have had a previous fragility fracture or hip fracture How many were referred to a Fracture Liaison Service (or equivalent follow-up)
How well is the Fracture Liaison Service integrated with the DHB falls prevention programme
Our data breakdown and comparisons Compared to the national mean of 23 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By age group in our DHB area in 2015 fall-related hip fractures for people 50+ were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 0265ndash74 years 1175ndash84 years 5585+ years 231
By gender in our DHB area in 2015 fall-related hip fractures for people 50+ were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 31Male 15
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 12
5
IND
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TOR Worksheet Percent hip fracture 50+ operated on the same or next day of
admission (DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of hip fractures related to a fall for people aged 50 and older were operated on the day of admission or the next day
The Australian and New Zealand Guideline for Hip Fracture Care recommends that surgery is carried out within 48 hours ie the same or next day following hip fracture
When interpreting this indicator it is important to remember there are a number of reasons why surgery might be delayed such as medical instability need for further investigation or resource constraints such as theatre availability
Looking at local data what are the most common reasons for surgery to be delayed for more than two days
To what extent can delayed surgery be explained by demands on acute theatre resources
What other factors are causing delay to surgery in our DHB Is there a fast-track pathway in place for acute hip fracture If not what are the barriers to
providing one
Our data breakdown and comparisons The percentage in our DHB area is what Compared to the national mean of 764 percent this
is statistically significantly lowerno differentsignificantly higher Compared to what percent in name a similar DHB area our percent is statistically significantly
lowerno differentsignificantly higher
By year 2013-15 in our DHB area percentage and count of hip fractures operated on the day of admission or the next day were
Year National mean Our DHB areaPercentage Count Percentage
2013 7162014 7442015 764
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 13
6
IND
ICA
TOR Worksheet Percent bisphosphonate on discharge following hip fracture
(DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensed a bisphosphonate within six months of discharge from a hospital admission with a hip fracture
A review of bone health is recommended following a hip fracture this includes considering the use of bisphosphonatesa Bisphosphonates are used to reduce bone density loss and are indicated for the prevention and treatment of osteoporosis There is also evidence that bisphosphonates can reduce the risk of osteoporotic fractures however they may not be appropriate for patients with renal failure or a life expectancy of less than two years
Bisphosphonates should be used in conjunction with other individualised falls prevention interventions such as exercise to improve balance and strength and home safety assessment and modifications
Do DHBs with orthogeriatric services andor closely linked Fracture Liaison Services have higher rates of prescribing than those who donrsquot have these services
To what extent do clinical factors such as renal failure or life expectancy judgement explain the rate of bisphosphonate use
Our data breakdown and comparisons Compared to the national mean of 212 percent what percent is statistically significantly
lowerno differentsignificantly higher Compared to the rate of what percent in name a similar DHB area our percent is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentage and count of bisphosphonate dispensing were
Year National mean Our DHB areaPercent Count Percent
2013 2862014 2092015 212
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfBoneCare 2020A systematic approach to hip fracture care and prevention for New Zealand published by Osteoporosis New ZealandStrategies to improve hip fracture prevention and care pdf ndash summarises Bone Care 2020 and provides a four-step check for your local review
a
Workbook From Atlas to Action (2015 data) published March 2017 page 14
7
IND
ICA
TOR Worksheet Percent vitamin D on discharge for hip fracture (DHB of
service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensedb vitamin D within six months of discharge from a hospital admission with a hip fracture
Because vitamin D is essential for bone health and muscle function assessment of risk of vitamin D deficiency is recommended for all older people Health professionals prescribing vitamin D supplements assess the individual and take into account any contraindications
The Atlas shows wide variations between DHBs in the use of vitamin D following hip fracture
Why are some DHBs consistently lower or higher than the national mean How do similar DHBs compare What might the ideal rate of vitamin D use be What might be barriers to increasing rates of prescribing and how might we address
them
Our data breakdown and comparisons Compared to the national mean of 682 percent our rate of what percent is statistically
significantly lowerno differentsignificantly higher Compared to the rate of figure percent in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentages and count of prescribed vitamin D supplement dispensing were
Year National mean Our DHB areaPercentage Count Percentage
2013 7242014 6792015 682
RESOURCESTopic 7 Vitamin D and falls what you need to know pdfThe Ministry of Health and Cancer Societyrsquos Consensus Statement on Vitamin D and Sun Exposure in New Zealand ACC information for prescribers in general practice teams and staff working in residential care
b This data is from the Pharmaceutical Collection which captures prescribed medicines dispensed in a community pharmacy This indicator does not reflect over-the-counter vitamin D supplement use or whether or not medicine was taken The national programme recommends that vitamin D supplements are prescribed by a health practitioner after assessment of the older persons vitamin D status
Workbook From Atlas to Action (2015 data) published March 2017 page 15
8
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
Whats in this Workbook
How to use the Workbook 1
From Atlas to Action key resources 2
Highlights from the evidence what works 3
Key indicator summary for our DHB area and implications 4
Worksheets for indicators in the Atlas of Healthcare Variation falls domain
1 People 50+ with one or more ACC claim for a fall 5
2 People 50+ with one or more hospital admissions due to a fall 6
3 People 50+ admitted for more than one day due to a fall 7
4 Average bed-days for people 50+ admitted with a fall (DHB of domicile) 8
5 Hip fracture 50+ due to a fall (DHB of domicile) 9
6 Percent hip fracture 50+ operated on the same or next day of admission (DHB of service)
10
7 Percent bisphosphonate on discharge following hip fracture (DHB of service) 11
8 Percent vitamin D on discharge following hip fracture (DHB of service) 12
OTHER RESOURCES
Tutorial using the bar chart to determine statistical significance 13
Understanding variation
The goal of the falls domain was to explore any areas of wide variation between DHBs and identify possible areas for local quality improvement In particular we are interested in identifying lsquounwarrantedrsquo variation that is variation in health service use that cannot be explained by differences in patient illness or preferences
Resources on the health quality evaluation webpages are
Variation in medical practice literature review and discussion
Addressing unwarranted variation literature review on methods for influencing practice
Variation and improving services analysing and interpreting variation
Selected references1 Rubenstein LZ 2006 Falls in older people epidemiology risk factors and strategies for prevention
Age and Ageing 35ndashS2ii37ndashii412 Gillespie LD Robertson MC Gillespie WJ et al 2012 Interventions for preventing falls in older people
living in the community Cochrane Database of Systematic Reviews (9) CD0071463 Cameron ID Gillespie LD Robertson MC et al 2012 Interventions for preventing falls in older people
in care facilities and hospitals Cochrane Database of Systematic Reviews (12) CD0054654 Carande-Kulis V Stevens JA Florence CS et al 2015 A costndashbenefit analysis of three older adult fall
prevention interventions Journal of Safety Research 52 65ndash705 Gallagher JC Melton LJ Riggs BL et al 1980 Epidemiology of fractures of the proximal femur in
Rochester Minnesota Clinical Orthopaedics and Related Research 150 163ndash716 Port L Center J Briffa NK et al 2003 Osteoporotic fracture missed opportunity for intervention
Osteoporosis International 14(9) 780ndash4
How to use the Workbook
We recommended that data from the Atlas of Healthcare Variation falls domain are reviewed at all levels of clinical governance
The workbook is designed to support structured discussion on each of the eight indicators looking at the incidence of fall-related injuries and aspects of treatment in people aged 50 and older
It may be appropriate that your DHB areas data is entered into the worksheets as a first step (the workbook is provided in a Word format to allow you to customise the content)
WORKBOOK FEATURES
Highlights from the evidence for preventing falls and reducing harm from falls ndash key points relevant for community-wide planning to inform your discussion of Atlas data in the worksheet for each indicator
Worksheets for each indicator suggest key questions for discussion directing attention to immediate gains with high-risk
groups and longer-term gains in a population health approach allow you to record Atlas data in a breakdown of ethnicity age group and gender
add figures or edit text at the grey highlight in some places youll need to calculate percentage with reference to the preceding
figures suggest comparisons using the bar chart with the national mean and a similar DHB area
We recommend you enter your DHB areas data in the worksheets ahead of discussion and work through all questions before summarising your discussion in the key indicator summary (page 4)
Key indicator summary ndash complete this page to summarise your discussion of data from the worksheets These three indicators help focus on planning implications for the incidence of
fall-related injuries treated in the community hospital admissions for fall-related injuries hip fracture due to a fall
RESOURCES 10 Topics in reducing harm from falls and other resources developed in the national falls
programme are matched to the issues and questions raised by the Atlas indicators Theres a tutorial at the end of this workbook on using the bar chart to determine whether or
not differences against the national mean and between DHBs are statistically significant
See also Resources and activities on the Commissions reducing harm from falls web pages
FEEDBACKPlease provide feedback on the Workbook and your experience of using it to infohqscgovtnz
Wed particularly like to hear about any questions prompted by the data that havent been mentioned in the Workbook We may include your insights in any future revisions
Workbook From Atlas to Action (2015 data) published March 2017 page 1
From Atlas to Action key resources
Atlas of Healthcare Variation falls domain The falls domain was originally developed by an expert advisory group (EAG) convened by the Health Quality amp Safety Commission in 2013 In 2016 it was updated with 2014 data and now in April 2017 it has been updated with 2015 data The EAG includes members of the EAG for the national falls programme Reducing Harm from Falls The falls domain gives clinicians patients and providers an overview of the prevalence of falls in people aged 50 and older including those treated in the community and in hospital
Find the falls Atlas domain here
The falls Atlas domain presents data on eight indicators by DHB areas in an interactive map tables and bar graph Read the relevant commentary online while using the worksheet for each indicator
WebinarFrom Atlas to Action ndash How to use the Atlas of Healthcare falls domainwith Dr Shankar Sankaran from Counties Manukau Health falls Clinical Lead Sandy Blake and theHealth Quality amp Safety Commissionrsquos Catherine Gerard
The webinar from Tuesday 14 April 2015 is available here and it is still relevant to help users with the April 2017 update
Patient perspective this story could have been differentKeep the focus on the userrsquos perspective to plan and provide integrated servicesFind it here
These short summaries of current evidence and best practice cover core issues in falls prevention for older people and introduce the resources and videos developed in the national programme Links to the relevant Topic are given on the worksheet for each Atlas indicator to help inform your reflection and discussion
Workbook From Atlas to Action (2015 data) published March 2017 page 2
Highlights from the evidence what works
A summary of findings in the falls Atlas data for 2015 confirms that for people aged 65 and older falls are a major cause of injury
110300 had at least one ACC claim in 2015 due to a fall in other words 300 ACC claims were accepted every day
20580 were admitted to hospital after a fall
3404 of these admissions were for a fall-related hip fracture
Among those aged 85 and older 26 percent had one or more ACC claim and of these 33 percent were admitted to hospital for more than one day as a result of their fall with an average length of stay of 14 days
However falls are not an inevitable part of ageing ndash there is strong evidence for preventing falls and reducing harm from falls Effective interventions ndash when implemented ndash reduce the impact of falls and reduce costs at individual system and population levels
The expert advisory group for the national falls programme asks you to give attention to these highlights from the evidence as to what works
Exercise to improve balance and strength is cost-effective
A costndashbenefit analysis published in early 2015 reviewed three falls prevention programmes for older people on the basis that they demonstrated a high level of effectiveness in randomised controlled trials had been implemented in community settings and were appropriate for people with differing levels of falls risk The programmes were the Otago Exercise Programme for people aged 65 and older or 80 and older Tai Chi Moving for Better Balance and Stepping On Analysis of the return on investment for these programmes showed that the benefits not only covered the implementation costs but also exceeded the expected direct medical costs4 ndash in other words these programmes prevented falls and provided a substantial return on investment
Home safety assessment and modification is effective for those at higher risk of falling
The 2012 Cochrane review on preventing falls in older people living in the community presents strong evidence from randomised controlled trials in the older age group that home safety assessment and modification programmes are effective in reducing falls particularly those at a higher risk of falling and when the programme is delivered by an occupational therapist
Multifactorial risk assessment and individualised interventions
Health professionals can ask older people about falls and injuries and work with them and their families to reduce the risk of falls and related injuries Although there are common risk factors in
the age group every older person is different and needs an individualised plan of care that addresses their particular risk factors through appropriate treatments and referrals
Short length of stay in acute care settings makes this approach more challenging but multifactorial interventions are effective for reducing the number of falls in older people living in the community
Workbook From Atlas to Action (2015 data) published March 2017 page 3
Key indicator summary for our DHB area and implications
Summary of data and responses from worksheets to inform planning
INDICATOR
1 ACC claims for fall-related injuries Nationally 217000 people aged 50 and older had an ACC claim for a fall-related injury accepted in 2015 People aged 85 and over were twice as likely to have an ACC claim for a fall-related injury and were 15 times more likely to be admitted to hospital as a result
Falls Atlas Indicator 1 key points for action from the data and questions
INDICATOR
3 Hospital admissions for fall-related injuries Nationally 20100 people aged 50 and older were admitted to hospital for more than one day due to a fall-related injury in 2015
Falls Atlas Indicator 3 key points for action from the data and questions
INDICATOR
5 Hip fracture due to a fallNationally 3600 people aged 50 and older had a fall-related hip fracture in 2015
Falls Atlas Indicator 5 key points for action from the data and questions
Implications from the data for our DHB area
Given the ageing population and the points noted above implications for planning and providing an integrated approach in our DHB area are as follows describe
Workbook From Atlas to Action (2015 data) published March 2017 page 4
IND
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Worksheet People 50+ with one or more ACC claim for a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ with one or more ACC claims
Nationally 26 percent of those aged 85 and older have at least one ACC claim for a fall each year What is the data in the age group table below telling us
Not all fall-related injuries are captured in this data set (ie not reported by patients not medically treated or not claimed for or more than one claim) What assumptions can we make about the rate of falls with injury What can we do to elicit better falls histories
Given the high incidence of falls with injury what is being done community-wide to reduce falls in the frail elderly Are there established programmes and referral pathways
What screening and interventions are undertaken routinely to reduce injury related to falling eg assessment of bone health for detection and treatment of osteoporosis
Our data breakdown and comparisons Compared to the national mean of 142 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher
Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 967Pacific 1037Asian 861All other ethnicities 1543
By age group in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 12565ndash74 years 13575ndash84 years 17985+ years 264
By gender in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 1565Male 1257
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 5
1
Workbook From Atlas to Action (2015 data) published March 2017 page 6
IND
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People 50+ with one or more hospital admissions due to a fall
Indicator 3 (admissions for more than one day) has been selected for attention in this Workbook as a useful subset of all hospital admissions Indicator 2 includes admissions to emergency departments which may be influenced by factors such as availability of or access to after-hours primary care
Workbook From Atlas to Action (2015 data) published March 2017 page 7
2
IND
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Worksheet People 50+ admitted for more than one day due to a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ admitted for more than one day due to a fall
This indicator only looks at one fall-related admission per person in a year Do we know how many people had more than one admission for a fall-related injury in a year
Older people admitted due to a fall are by definition at risk of falling and should have their risk factors assessed and addressed in an individualised care plan Is this reflected in the report on our quality and safety markers for falls
Do we know how well we addressed these patients risk factors ndash either as an inpatient or follow-up with GP andor other services For instance medicine use could be reviewed in hospital whereas optimising an older persons vision may be a post-discharge referral
Our data breakdown and comparisons Compared to the national mean of 131 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 76Pacific 79Asian 56All other ethnicities 147
By age group in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 4165ndash74 years 9475ndash84 years 2985+ years 872
By gender in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 156Male 104
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 8
3
Workbook From Atlas to Action (2015 data) published March 2017 page 9
IND
ICA
TOR Worksheet Average bed-days for people 50+ admitted with a fall (DHB of
domicile)
Our data what questions should we ask
In 2015 in our DHB area the average bed-days were number for people aged 50 and older admitted in relation to a fall
Patients admitted with a fall are at risk of further falls as an inpatient (and after discharge) ndash what processes are in place for assessing risk of falling and implementing individualised interventions
What measures are in place to ensure a safe environment and safe care for these and all inpatients Do we audit the safety of the environment in relation to falls
Does use of interim care schemes explain any of the observed variation
How much variation can be explained by severity of injury or frailty
Our data breakdown and comparisons Compared to the national mean of 103 bed-days our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Ethnicity (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Māori 67Pacific 76Asian 84All other ethnicities 106
By age group in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Age group (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
50ndash64 years 4565ndash74 years 875ndash84 years 11685+ years 14
By gender in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Gender (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Female 109Male 92
RESOURCES
Topic 4 Safe environment and safe care essential in preventing falls pdfApril audit How safe is the care environment today Word doc
Workbook From Atlas to Action (2015 data) published March 2017 page 10
4
Workbook From Atlas to Action (2015 data) published March 2017 page 11
IND
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Worksheet Hip fracture 50+ due to a fall (DHB of domicile)
Our data what questions should we ask
In 2015 in our DHB area hip fractures related to a fall for people aged 50 and older were number Although those in the age group 85 and older make up only 5 percent of the total population nationally in 2015 they represented half of all hip fractures in those aged 50 and older
At least half of the people who break their hip have suffered a prior fragility fracture23 signalling the need for multifactorial interventions directed to reducing their risk of falling and reducing their risk of injury eg treating osteoporosis
What additional data do we have to answer these questions
How many hip fracture patients were previously admitted for a fall-related injury How many have had a previous fragility fracture or hip fracture How many were referred to a Fracture Liaison Service (or equivalent follow-up)
How well is the Fracture Liaison Service integrated with the DHB falls prevention programme
Our data breakdown and comparisons Compared to the national mean of 23 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By age group in our DHB area in 2015 fall-related hip fractures for people 50+ were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 0265ndash74 years 1175ndash84 years 5585+ years 231
By gender in our DHB area in 2015 fall-related hip fractures for people 50+ were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 31Male 15
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 12
5
IND
ICA
TOR Worksheet Percent hip fracture 50+ operated on the same or next day of
admission (DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of hip fractures related to a fall for people aged 50 and older were operated on the day of admission or the next day
The Australian and New Zealand Guideline for Hip Fracture Care recommends that surgery is carried out within 48 hours ie the same or next day following hip fracture
When interpreting this indicator it is important to remember there are a number of reasons why surgery might be delayed such as medical instability need for further investigation or resource constraints such as theatre availability
Looking at local data what are the most common reasons for surgery to be delayed for more than two days
To what extent can delayed surgery be explained by demands on acute theatre resources
What other factors are causing delay to surgery in our DHB Is there a fast-track pathway in place for acute hip fracture If not what are the barriers to
providing one
Our data breakdown and comparisons The percentage in our DHB area is what Compared to the national mean of 764 percent this
is statistically significantly lowerno differentsignificantly higher Compared to what percent in name a similar DHB area our percent is statistically significantly
lowerno differentsignificantly higher
By year 2013-15 in our DHB area percentage and count of hip fractures operated on the day of admission or the next day were
Year National mean Our DHB areaPercentage Count Percentage
2013 7162014 7442015 764
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 13
6
IND
ICA
TOR Worksheet Percent bisphosphonate on discharge following hip fracture
(DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensed a bisphosphonate within six months of discharge from a hospital admission with a hip fracture
A review of bone health is recommended following a hip fracture this includes considering the use of bisphosphonatesa Bisphosphonates are used to reduce bone density loss and are indicated for the prevention and treatment of osteoporosis There is also evidence that bisphosphonates can reduce the risk of osteoporotic fractures however they may not be appropriate for patients with renal failure or a life expectancy of less than two years
Bisphosphonates should be used in conjunction with other individualised falls prevention interventions such as exercise to improve balance and strength and home safety assessment and modifications
Do DHBs with orthogeriatric services andor closely linked Fracture Liaison Services have higher rates of prescribing than those who donrsquot have these services
To what extent do clinical factors such as renal failure or life expectancy judgement explain the rate of bisphosphonate use
Our data breakdown and comparisons Compared to the national mean of 212 percent what percent is statistically significantly
lowerno differentsignificantly higher Compared to the rate of what percent in name a similar DHB area our percent is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentage and count of bisphosphonate dispensing were
Year National mean Our DHB areaPercent Count Percent
2013 2862014 2092015 212
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfBoneCare 2020A systematic approach to hip fracture care and prevention for New Zealand published by Osteoporosis New ZealandStrategies to improve hip fracture prevention and care pdf ndash summarises Bone Care 2020 and provides a four-step check for your local review
a
Workbook From Atlas to Action (2015 data) published March 2017 page 14
7
IND
ICA
TOR Worksheet Percent vitamin D on discharge for hip fracture (DHB of
service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensedb vitamin D within six months of discharge from a hospital admission with a hip fracture
Because vitamin D is essential for bone health and muscle function assessment of risk of vitamin D deficiency is recommended for all older people Health professionals prescribing vitamin D supplements assess the individual and take into account any contraindications
The Atlas shows wide variations between DHBs in the use of vitamin D following hip fracture
Why are some DHBs consistently lower or higher than the national mean How do similar DHBs compare What might the ideal rate of vitamin D use be What might be barriers to increasing rates of prescribing and how might we address
them
Our data breakdown and comparisons Compared to the national mean of 682 percent our rate of what percent is statistically
significantly lowerno differentsignificantly higher Compared to the rate of figure percent in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentages and count of prescribed vitamin D supplement dispensing were
Year National mean Our DHB areaPercentage Count Percentage
2013 7242014 6792015 682
RESOURCESTopic 7 Vitamin D and falls what you need to know pdfThe Ministry of Health and Cancer Societyrsquos Consensus Statement on Vitamin D and Sun Exposure in New Zealand ACC information for prescribers in general practice teams and staff working in residential care
b This data is from the Pharmaceutical Collection which captures prescribed medicines dispensed in a community pharmacy This indicator does not reflect over-the-counter vitamin D supplement use or whether or not medicine was taken The national programme recommends that vitamin D supplements are prescribed by a health practitioner after assessment of the older persons vitamin D status
Workbook From Atlas to Action (2015 data) published March 2017 page 15
8
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
How to use the Workbook
We recommended that data from the Atlas of Healthcare Variation falls domain are reviewed at all levels of clinical governance
The workbook is designed to support structured discussion on each of the eight indicators looking at the incidence of fall-related injuries and aspects of treatment in people aged 50 and older
It may be appropriate that your DHB areas data is entered into the worksheets as a first step (the workbook is provided in a Word format to allow you to customise the content)
WORKBOOK FEATURES
Highlights from the evidence for preventing falls and reducing harm from falls ndash key points relevant for community-wide planning to inform your discussion of Atlas data in the worksheet for each indicator
Worksheets for each indicator suggest key questions for discussion directing attention to immediate gains with high-risk
groups and longer-term gains in a population health approach allow you to record Atlas data in a breakdown of ethnicity age group and gender
add figures or edit text at the grey highlight in some places youll need to calculate percentage with reference to the preceding
figures suggest comparisons using the bar chart with the national mean and a similar DHB area
We recommend you enter your DHB areas data in the worksheets ahead of discussion and work through all questions before summarising your discussion in the key indicator summary (page 4)
Key indicator summary ndash complete this page to summarise your discussion of data from the worksheets These three indicators help focus on planning implications for the incidence of
fall-related injuries treated in the community hospital admissions for fall-related injuries hip fracture due to a fall
RESOURCES 10 Topics in reducing harm from falls and other resources developed in the national falls
programme are matched to the issues and questions raised by the Atlas indicators Theres a tutorial at the end of this workbook on using the bar chart to determine whether or
not differences against the national mean and between DHBs are statistically significant
See also Resources and activities on the Commissions reducing harm from falls web pages
FEEDBACKPlease provide feedback on the Workbook and your experience of using it to infohqscgovtnz
Wed particularly like to hear about any questions prompted by the data that havent been mentioned in the Workbook We may include your insights in any future revisions
Workbook From Atlas to Action (2015 data) published March 2017 page 1
From Atlas to Action key resources
Atlas of Healthcare Variation falls domain The falls domain was originally developed by an expert advisory group (EAG) convened by the Health Quality amp Safety Commission in 2013 In 2016 it was updated with 2014 data and now in April 2017 it has been updated with 2015 data The EAG includes members of the EAG for the national falls programme Reducing Harm from Falls The falls domain gives clinicians patients and providers an overview of the prevalence of falls in people aged 50 and older including those treated in the community and in hospital
Find the falls Atlas domain here
The falls Atlas domain presents data on eight indicators by DHB areas in an interactive map tables and bar graph Read the relevant commentary online while using the worksheet for each indicator
WebinarFrom Atlas to Action ndash How to use the Atlas of Healthcare falls domainwith Dr Shankar Sankaran from Counties Manukau Health falls Clinical Lead Sandy Blake and theHealth Quality amp Safety Commissionrsquos Catherine Gerard
The webinar from Tuesday 14 April 2015 is available here and it is still relevant to help users with the April 2017 update
Patient perspective this story could have been differentKeep the focus on the userrsquos perspective to plan and provide integrated servicesFind it here
These short summaries of current evidence and best practice cover core issues in falls prevention for older people and introduce the resources and videos developed in the national programme Links to the relevant Topic are given on the worksheet for each Atlas indicator to help inform your reflection and discussion
Workbook From Atlas to Action (2015 data) published March 2017 page 2
Highlights from the evidence what works
A summary of findings in the falls Atlas data for 2015 confirms that for people aged 65 and older falls are a major cause of injury
110300 had at least one ACC claim in 2015 due to a fall in other words 300 ACC claims were accepted every day
20580 were admitted to hospital after a fall
3404 of these admissions were for a fall-related hip fracture
Among those aged 85 and older 26 percent had one or more ACC claim and of these 33 percent were admitted to hospital for more than one day as a result of their fall with an average length of stay of 14 days
However falls are not an inevitable part of ageing ndash there is strong evidence for preventing falls and reducing harm from falls Effective interventions ndash when implemented ndash reduce the impact of falls and reduce costs at individual system and population levels
The expert advisory group for the national falls programme asks you to give attention to these highlights from the evidence as to what works
Exercise to improve balance and strength is cost-effective
A costndashbenefit analysis published in early 2015 reviewed three falls prevention programmes for older people on the basis that they demonstrated a high level of effectiveness in randomised controlled trials had been implemented in community settings and were appropriate for people with differing levels of falls risk The programmes were the Otago Exercise Programme for people aged 65 and older or 80 and older Tai Chi Moving for Better Balance and Stepping On Analysis of the return on investment for these programmes showed that the benefits not only covered the implementation costs but also exceeded the expected direct medical costs4 ndash in other words these programmes prevented falls and provided a substantial return on investment
Home safety assessment and modification is effective for those at higher risk of falling
The 2012 Cochrane review on preventing falls in older people living in the community presents strong evidence from randomised controlled trials in the older age group that home safety assessment and modification programmes are effective in reducing falls particularly those at a higher risk of falling and when the programme is delivered by an occupational therapist
Multifactorial risk assessment and individualised interventions
Health professionals can ask older people about falls and injuries and work with them and their families to reduce the risk of falls and related injuries Although there are common risk factors in
the age group every older person is different and needs an individualised plan of care that addresses their particular risk factors through appropriate treatments and referrals
Short length of stay in acute care settings makes this approach more challenging but multifactorial interventions are effective for reducing the number of falls in older people living in the community
Workbook From Atlas to Action (2015 data) published March 2017 page 3
Key indicator summary for our DHB area and implications
Summary of data and responses from worksheets to inform planning
INDICATOR
1 ACC claims for fall-related injuries Nationally 217000 people aged 50 and older had an ACC claim for a fall-related injury accepted in 2015 People aged 85 and over were twice as likely to have an ACC claim for a fall-related injury and were 15 times more likely to be admitted to hospital as a result
Falls Atlas Indicator 1 key points for action from the data and questions
INDICATOR
3 Hospital admissions for fall-related injuries Nationally 20100 people aged 50 and older were admitted to hospital for more than one day due to a fall-related injury in 2015
Falls Atlas Indicator 3 key points for action from the data and questions
INDICATOR
5 Hip fracture due to a fallNationally 3600 people aged 50 and older had a fall-related hip fracture in 2015
Falls Atlas Indicator 5 key points for action from the data and questions
Implications from the data for our DHB area
Given the ageing population and the points noted above implications for planning and providing an integrated approach in our DHB area are as follows describe
Workbook From Atlas to Action (2015 data) published March 2017 page 4
IND
ICA
TOR
Worksheet People 50+ with one or more ACC claim for a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ with one or more ACC claims
Nationally 26 percent of those aged 85 and older have at least one ACC claim for a fall each year What is the data in the age group table below telling us
Not all fall-related injuries are captured in this data set (ie not reported by patients not medically treated or not claimed for or more than one claim) What assumptions can we make about the rate of falls with injury What can we do to elicit better falls histories
Given the high incidence of falls with injury what is being done community-wide to reduce falls in the frail elderly Are there established programmes and referral pathways
What screening and interventions are undertaken routinely to reduce injury related to falling eg assessment of bone health for detection and treatment of osteoporosis
Our data breakdown and comparisons Compared to the national mean of 142 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher
Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 967Pacific 1037Asian 861All other ethnicities 1543
By age group in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 12565ndash74 years 13575ndash84 years 17985+ years 264
By gender in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 1565Male 1257
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 5
1
Workbook From Atlas to Action (2015 data) published March 2017 page 6
IND
ICA
TOR
People 50+ with one or more hospital admissions due to a fall
Indicator 3 (admissions for more than one day) has been selected for attention in this Workbook as a useful subset of all hospital admissions Indicator 2 includes admissions to emergency departments which may be influenced by factors such as availability of or access to after-hours primary care
Workbook From Atlas to Action (2015 data) published March 2017 page 7
2
IND
ICA
TOR
Worksheet People 50+ admitted for more than one day due to a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ admitted for more than one day due to a fall
This indicator only looks at one fall-related admission per person in a year Do we know how many people had more than one admission for a fall-related injury in a year
Older people admitted due to a fall are by definition at risk of falling and should have their risk factors assessed and addressed in an individualised care plan Is this reflected in the report on our quality and safety markers for falls
Do we know how well we addressed these patients risk factors ndash either as an inpatient or follow-up with GP andor other services For instance medicine use could be reviewed in hospital whereas optimising an older persons vision may be a post-discharge referral
Our data breakdown and comparisons Compared to the national mean of 131 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 76Pacific 79Asian 56All other ethnicities 147
By age group in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 4165ndash74 years 9475ndash84 years 2985+ years 872
By gender in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 156Male 104
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 8
3
Workbook From Atlas to Action (2015 data) published March 2017 page 9
IND
ICA
TOR Worksheet Average bed-days for people 50+ admitted with a fall (DHB of
domicile)
Our data what questions should we ask
In 2015 in our DHB area the average bed-days were number for people aged 50 and older admitted in relation to a fall
Patients admitted with a fall are at risk of further falls as an inpatient (and after discharge) ndash what processes are in place for assessing risk of falling and implementing individualised interventions
What measures are in place to ensure a safe environment and safe care for these and all inpatients Do we audit the safety of the environment in relation to falls
Does use of interim care schemes explain any of the observed variation
How much variation can be explained by severity of injury or frailty
Our data breakdown and comparisons Compared to the national mean of 103 bed-days our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Ethnicity (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Māori 67Pacific 76Asian 84All other ethnicities 106
By age group in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Age group (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
50ndash64 years 4565ndash74 years 875ndash84 years 11685+ years 14
By gender in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Gender (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Female 109Male 92
RESOURCES
Topic 4 Safe environment and safe care essential in preventing falls pdfApril audit How safe is the care environment today Word doc
Workbook From Atlas to Action (2015 data) published March 2017 page 10
4
Workbook From Atlas to Action (2015 data) published March 2017 page 11
IND
ICA
TOR
Worksheet Hip fracture 50+ due to a fall (DHB of domicile)
Our data what questions should we ask
In 2015 in our DHB area hip fractures related to a fall for people aged 50 and older were number Although those in the age group 85 and older make up only 5 percent of the total population nationally in 2015 they represented half of all hip fractures in those aged 50 and older
At least half of the people who break their hip have suffered a prior fragility fracture23 signalling the need for multifactorial interventions directed to reducing their risk of falling and reducing their risk of injury eg treating osteoporosis
What additional data do we have to answer these questions
How many hip fracture patients were previously admitted for a fall-related injury How many have had a previous fragility fracture or hip fracture How many were referred to a Fracture Liaison Service (or equivalent follow-up)
How well is the Fracture Liaison Service integrated with the DHB falls prevention programme
Our data breakdown and comparisons Compared to the national mean of 23 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By age group in our DHB area in 2015 fall-related hip fractures for people 50+ were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 0265ndash74 years 1175ndash84 years 5585+ years 231
By gender in our DHB area in 2015 fall-related hip fractures for people 50+ were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 31Male 15
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 12
5
IND
ICA
TOR Worksheet Percent hip fracture 50+ operated on the same or next day of
admission (DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of hip fractures related to a fall for people aged 50 and older were operated on the day of admission or the next day
The Australian and New Zealand Guideline for Hip Fracture Care recommends that surgery is carried out within 48 hours ie the same or next day following hip fracture
When interpreting this indicator it is important to remember there are a number of reasons why surgery might be delayed such as medical instability need for further investigation or resource constraints such as theatre availability
Looking at local data what are the most common reasons for surgery to be delayed for more than two days
To what extent can delayed surgery be explained by demands on acute theatre resources
What other factors are causing delay to surgery in our DHB Is there a fast-track pathway in place for acute hip fracture If not what are the barriers to
providing one
Our data breakdown and comparisons The percentage in our DHB area is what Compared to the national mean of 764 percent this
is statistically significantly lowerno differentsignificantly higher Compared to what percent in name a similar DHB area our percent is statistically significantly
lowerno differentsignificantly higher
By year 2013-15 in our DHB area percentage and count of hip fractures operated on the day of admission or the next day were
Year National mean Our DHB areaPercentage Count Percentage
2013 7162014 7442015 764
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 13
6
IND
ICA
TOR Worksheet Percent bisphosphonate on discharge following hip fracture
(DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensed a bisphosphonate within six months of discharge from a hospital admission with a hip fracture
A review of bone health is recommended following a hip fracture this includes considering the use of bisphosphonatesa Bisphosphonates are used to reduce bone density loss and are indicated for the prevention and treatment of osteoporosis There is also evidence that bisphosphonates can reduce the risk of osteoporotic fractures however they may not be appropriate for patients with renal failure or a life expectancy of less than two years
Bisphosphonates should be used in conjunction with other individualised falls prevention interventions such as exercise to improve balance and strength and home safety assessment and modifications
Do DHBs with orthogeriatric services andor closely linked Fracture Liaison Services have higher rates of prescribing than those who donrsquot have these services
To what extent do clinical factors such as renal failure or life expectancy judgement explain the rate of bisphosphonate use
Our data breakdown and comparisons Compared to the national mean of 212 percent what percent is statistically significantly
lowerno differentsignificantly higher Compared to the rate of what percent in name a similar DHB area our percent is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentage and count of bisphosphonate dispensing were
Year National mean Our DHB areaPercent Count Percent
2013 2862014 2092015 212
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfBoneCare 2020A systematic approach to hip fracture care and prevention for New Zealand published by Osteoporosis New ZealandStrategies to improve hip fracture prevention and care pdf ndash summarises Bone Care 2020 and provides a four-step check for your local review
a
Workbook From Atlas to Action (2015 data) published March 2017 page 14
7
IND
ICA
TOR Worksheet Percent vitamin D on discharge for hip fracture (DHB of
service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensedb vitamin D within six months of discharge from a hospital admission with a hip fracture
Because vitamin D is essential for bone health and muscle function assessment of risk of vitamin D deficiency is recommended for all older people Health professionals prescribing vitamin D supplements assess the individual and take into account any contraindications
The Atlas shows wide variations between DHBs in the use of vitamin D following hip fracture
Why are some DHBs consistently lower or higher than the national mean How do similar DHBs compare What might the ideal rate of vitamin D use be What might be barriers to increasing rates of prescribing and how might we address
them
Our data breakdown and comparisons Compared to the national mean of 682 percent our rate of what percent is statistically
significantly lowerno differentsignificantly higher Compared to the rate of figure percent in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentages and count of prescribed vitamin D supplement dispensing were
Year National mean Our DHB areaPercentage Count Percentage
2013 7242014 6792015 682
RESOURCESTopic 7 Vitamin D and falls what you need to know pdfThe Ministry of Health and Cancer Societyrsquos Consensus Statement on Vitamin D and Sun Exposure in New Zealand ACC information for prescribers in general practice teams and staff working in residential care
b This data is from the Pharmaceutical Collection which captures prescribed medicines dispensed in a community pharmacy This indicator does not reflect over-the-counter vitamin D supplement use or whether or not medicine was taken The national programme recommends that vitamin D supplements are prescribed by a health practitioner after assessment of the older persons vitamin D status
Workbook From Atlas to Action (2015 data) published March 2017 page 15
8
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
From Atlas to Action key resources
Atlas of Healthcare Variation falls domain The falls domain was originally developed by an expert advisory group (EAG) convened by the Health Quality amp Safety Commission in 2013 In 2016 it was updated with 2014 data and now in April 2017 it has been updated with 2015 data The EAG includes members of the EAG for the national falls programme Reducing Harm from Falls The falls domain gives clinicians patients and providers an overview of the prevalence of falls in people aged 50 and older including those treated in the community and in hospital
Find the falls Atlas domain here
The falls Atlas domain presents data on eight indicators by DHB areas in an interactive map tables and bar graph Read the relevant commentary online while using the worksheet for each indicator
WebinarFrom Atlas to Action ndash How to use the Atlas of Healthcare falls domainwith Dr Shankar Sankaran from Counties Manukau Health falls Clinical Lead Sandy Blake and theHealth Quality amp Safety Commissionrsquos Catherine Gerard
The webinar from Tuesday 14 April 2015 is available here and it is still relevant to help users with the April 2017 update
Patient perspective this story could have been differentKeep the focus on the userrsquos perspective to plan and provide integrated servicesFind it here
These short summaries of current evidence and best practice cover core issues in falls prevention for older people and introduce the resources and videos developed in the national programme Links to the relevant Topic are given on the worksheet for each Atlas indicator to help inform your reflection and discussion
Workbook From Atlas to Action (2015 data) published March 2017 page 2
Highlights from the evidence what works
A summary of findings in the falls Atlas data for 2015 confirms that for people aged 65 and older falls are a major cause of injury
110300 had at least one ACC claim in 2015 due to a fall in other words 300 ACC claims were accepted every day
20580 were admitted to hospital after a fall
3404 of these admissions were for a fall-related hip fracture
Among those aged 85 and older 26 percent had one or more ACC claim and of these 33 percent were admitted to hospital for more than one day as a result of their fall with an average length of stay of 14 days
However falls are not an inevitable part of ageing ndash there is strong evidence for preventing falls and reducing harm from falls Effective interventions ndash when implemented ndash reduce the impact of falls and reduce costs at individual system and population levels
The expert advisory group for the national falls programme asks you to give attention to these highlights from the evidence as to what works
Exercise to improve balance and strength is cost-effective
A costndashbenefit analysis published in early 2015 reviewed three falls prevention programmes for older people on the basis that they demonstrated a high level of effectiveness in randomised controlled trials had been implemented in community settings and were appropriate for people with differing levels of falls risk The programmes were the Otago Exercise Programme for people aged 65 and older or 80 and older Tai Chi Moving for Better Balance and Stepping On Analysis of the return on investment for these programmes showed that the benefits not only covered the implementation costs but also exceeded the expected direct medical costs4 ndash in other words these programmes prevented falls and provided a substantial return on investment
Home safety assessment and modification is effective for those at higher risk of falling
The 2012 Cochrane review on preventing falls in older people living in the community presents strong evidence from randomised controlled trials in the older age group that home safety assessment and modification programmes are effective in reducing falls particularly those at a higher risk of falling and when the programme is delivered by an occupational therapist
Multifactorial risk assessment and individualised interventions
Health professionals can ask older people about falls and injuries and work with them and their families to reduce the risk of falls and related injuries Although there are common risk factors in
the age group every older person is different and needs an individualised plan of care that addresses their particular risk factors through appropriate treatments and referrals
Short length of stay in acute care settings makes this approach more challenging but multifactorial interventions are effective for reducing the number of falls in older people living in the community
Workbook From Atlas to Action (2015 data) published March 2017 page 3
Key indicator summary for our DHB area and implications
Summary of data and responses from worksheets to inform planning
INDICATOR
1 ACC claims for fall-related injuries Nationally 217000 people aged 50 and older had an ACC claim for a fall-related injury accepted in 2015 People aged 85 and over were twice as likely to have an ACC claim for a fall-related injury and were 15 times more likely to be admitted to hospital as a result
Falls Atlas Indicator 1 key points for action from the data and questions
INDICATOR
3 Hospital admissions for fall-related injuries Nationally 20100 people aged 50 and older were admitted to hospital for more than one day due to a fall-related injury in 2015
Falls Atlas Indicator 3 key points for action from the data and questions
INDICATOR
5 Hip fracture due to a fallNationally 3600 people aged 50 and older had a fall-related hip fracture in 2015
Falls Atlas Indicator 5 key points for action from the data and questions
Implications from the data for our DHB area
Given the ageing population and the points noted above implications for planning and providing an integrated approach in our DHB area are as follows describe
Workbook From Atlas to Action (2015 data) published March 2017 page 4
IND
ICA
TOR
Worksheet People 50+ with one or more ACC claim for a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ with one or more ACC claims
Nationally 26 percent of those aged 85 and older have at least one ACC claim for a fall each year What is the data in the age group table below telling us
Not all fall-related injuries are captured in this data set (ie not reported by patients not medically treated or not claimed for or more than one claim) What assumptions can we make about the rate of falls with injury What can we do to elicit better falls histories
Given the high incidence of falls with injury what is being done community-wide to reduce falls in the frail elderly Are there established programmes and referral pathways
What screening and interventions are undertaken routinely to reduce injury related to falling eg assessment of bone health for detection and treatment of osteoporosis
Our data breakdown and comparisons Compared to the national mean of 142 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher
Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 967Pacific 1037Asian 861All other ethnicities 1543
By age group in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 12565ndash74 years 13575ndash84 years 17985+ years 264
By gender in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 1565Male 1257
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 5
1
Workbook From Atlas to Action (2015 data) published March 2017 page 6
IND
ICA
TOR
People 50+ with one or more hospital admissions due to a fall
Indicator 3 (admissions for more than one day) has been selected for attention in this Workbook as a useful subset of all hospital admissions Indicator 2 includes admissions to emergency departments which may be influenced by factors such as availability of or access to after-hours primary care
Workbook From Atlas to Action (2015 data) published March 2017 page 7
2
IND
ICA
TOR
Worksheet People 50+ admitted for more than one day due to a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ admitted for more than one day due to a fall
This indicator only looks at one fall-related admission per person in a year Do we know how many people had more than one admission for a fall-related injury in a year
Older people admitted due to a fall are by definition at risk of falling and should have their risk factors assessed and addressed in an individualised care plan Is this reflected in the report on our quality and safety markers for falls
Do we know how well we addressed these patients risk factors ndash either as an inpatient or follow-up with GP andor other services For instance medicine use could be reviewed in hospital whereas optimising an older persons vision may be a post-discharge referral
Our data breakdown and comparisons Compared to the national mean of 131 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 76Pacific 79Asian 56All other ethnicities 147
By age group in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 4165ndash74 years 9475ndash84 years 2985+ years 872
By gender in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 156Male 104
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 8
3
Workbook From Atlas to Action (2015 data) published March 2017 page 9
IND
ICA
TOR Worksheet Average bed-days for people 50+ admitted with a fall (DHB of
domicile)
Our data what questions should we ask
In 2015 in our DHB area the average bed-days were number for people aged 50 and older admitted in relation to a fall
Patients admitted with a fall are at risk of further falls as an inpatient (and after discharge) ndash what processes are in place for assessing risk of falling and implementing individualised interventions
What measures are in place to ensure a safe environment and safe care for these and all inpatients Do we audit the safety of the environment in relation to falls
Does use of interim care schemes explain any of the observed variation
How much variation can be explained by severity of injury or frailty
Our data breakdown and comparisons Compared to the national mean of 103 bed-days our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Ethnicity (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Māori 67Pacific 76Asian 84All other ethnicities 106
By age group in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Age group (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
50ndash64 years 4565ndash74 years 875ndash84 years 11685+ years 14
By gender in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Gender (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Female 109Male 92
RESOURCES
Topic 4 Safe environment and safe care essential in preventing falls pdfApril audit How safe is the care environment today Word doc
Workbook From Atlas to Action (2015 data) published March 2017 page 10
4
Workbook From Atlas to Action (2015 data) published March 2017 page 11
IND
ICA
TOR
Worksheet Hip fracture 50+ due to a fall (DHB of domicile)
Our data what questions should we ask
In 2015 in our DHB area hip fractures related to a fall for people aged 50 and older were number Although those in the age group 85 and older make up only 5 percent of the total population nationally in 2015 they represented half of all hip fractures in those aged 50 and older
At least half of the people who break their hip have suffered a prior fragility fracture23 signalling the need for multifactorial interventions directed to reducing their risk of falling and reducing their risk of injury eg treating osteoporosis
What additional data do we have to answer these questions
How many hip fracture patients were previously admitted for a fall-related injury How many have had a previous fragility fracture or hip fracture How many were referred to a Fracture Liaison Service (or equivalent follow-up)
How well is the Fracture Liaison Service integrated with the DHB falls prevention programme
Our data breakdown and comparisons Compared to the national mean of 23 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By age group in our DHB area in 2015 fall-related hip fractures for people 50+ were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 0265ndash74 years 1175ndash84 years 5585+ years 231
By gender in our DHB area in 2015 fall-related hip fractures for people 50+ were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 31Male 15
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 12
5
IND
ICA
TOR Worksheet Percent hip fracture 50+ operated on the same or next day of
admission (DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of hip fractures related to a fall for people aged 50 and older were operated on the day of admission or the next day
The Australian and New Zealand Guideline for Hip Fracture Care recommends that surgery is carried out within 48 hours ie the same or next day following hip fracture
When interpreting this indicator it is important to remember there are a number of reasons why surgery might be delayed such as medical instability need for further investigation or resource constraints such as theatre availability
Looking at local data what are the most common reasons for surgery to be delayed for more than two days
To what extent can delayed surgery be explained by demands on acute theatre resources
What other factors are causing delay to surgery in our DHB Is there a fast-track pathway in place for acute hip fracture If not what are the barriers to
providing one
Our data breakdown and comparisons The percentage in our DHB area is what Compared to the national mean of 764 percent this
is statistically significantly lowerno differentsignificantly higher Compared to what percent in name a similar DHB area our percent is statistically significantly
lowerno differentsignificantly higher
By year 2013-15 in our DHB area percentage and count of hip fractures operated on the day of admission or the next day were
Year National mean Our DHB areaPercentage Count Percentage
2013 7162014 7442015 764
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 13
6
IND
ICA
TOR Worksheet Percent bisphosphonate on discharge following hip fracture
(DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensed a bisphosphonate within six months of discharge from a hospital admission with a hip fracture
A review of bone health is recommended following a hip fracture this includes considering the use of bisphosphonatesa Bisphosphonates are used to reduce bone density loss and are indicated for the prevention and treatment of osteoporosis There is also evidence that bisphosphonates can reduce the risk of osteoporotic fractures however they may not be appropriate for patients with renal failure or a life expectancy of less than two years
Bisphosphonates should be used in conjunction with other individualised falls prevention interventions such as exercise to improve balance and strength and home safety assessment and modifications
Do DHBs with orthogeriatric services andor closely linked Fracture Liaison Services have higher rates of prescribing than those who donrsquot have these services
To what extent do clinical factors such as renal failure or life expectancy judgement explain the rate of bisphosphonate use
Our data breakdown and comparisons Compared to the national mean of 212 percent what percent is statistically significantly
lowerno differentsignificantly higher Compared to the rate of what percent in name a similar DHB area our percent is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentage and count of bisphosphonate dispensing were
Year National mean Our DHB areaPercent Count Percent
2013 2862014 2092015 212
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfBoneCare 2020A systematic approach to hip fracture care and prevention for New Zealand published by Osteoporosis New ZealandStrategies to improve hip fracture prevention and care pdf ndash summarises Bone Care 2020 and provides a four-step check for your local review
a
Workbook From Atlas to Action (2015 data) published March 2017 page 14
7
IND
ICA
TOR Worksheet Percent vitamin D on discharge for hip fracture (DHB of
service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensedb vitamin D within six months of discharge from a hospital admission with a hip fracture
Because vitamin D is essential for bone health and muscle function assessment of risk of vitamin D deficiency is recommended for all older people Health professionals prescribing vitamin D supplements assess the individual and take into account any contraindications
The Atlas shows wide variations between DHBs in the use of vitamin D following hip fracture
Why are some DHBs consistently lower or higher than the national mean How do similar DHBs compare What might the ideal rate of vitamin D use be What might be barriers to increasing rates of prescribing and how might we address
them
Our data breakdown and comparisons Compared to the national mean of 682 percent our rate of what percent is statistically
significantly lowerno differentsignificantly higher Compared to the rate of figure percent in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentages and count of prescribed vitamin D supplement dispensing were
Year National mean Our DHB areaPercentage Count Percentage
2013 7242014 6792015 682
RESOURCESTopic 7 Vitamin D and falls what you need to know pdfThe Ministry of Health and Cancer Societyrsquos Consensus Statement on Vitamin D and Sun Exposure in New Zealand ACC information for prescribers in general practice teams and staff working in residential care
b This data is from the Pharmaceutical Collection which captures prescribed medicines dispensed in a community pharmacy This indicator does not reflect over-the-counter vitamin D supplement use or whether or not medicine was taken The national programme recommends that vitamin D supplements are prescribed by a health practitioner after assessment of the older persons vitamin D status
Workbook From Atlas to Action (2015 data) published March 2017 page 15
8
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
Highlights from the evidence what works
A summary of findings in the falls Atlas data for 2015 confirms that for people aged 65 and older falls are a major cause of injury
110300 had at least one ACC claim in 2015 due to a fall in other words 300 ACC claims were accepted every day
20580 were admitted to hospital after a fall
3404 of these admissions were for a fall-related hip fracture
Among those aged 85 and older 26 percent had one or more ACC claim and of these 33 percent were admitted to hospital for more than one day as a result of their fall with an average length of stay of 14 days
However falls are not an inevitable part of ageing ndash there is strong evidence for preventing falls and reducing harm from falls Effective interventions ndash when implemented ndash reduce the impact of falls and reduce costs at individual system and population levels
The expert advisory group for the national falls programme asks you to give attention to these highlights from the evidence as to what works
Exercise to improve balance and strength is cost-effective
A costndashbenefit analysis published in early 2015 reviewed three falls prevention programmes for older people on the basis that they demonstrated a high level of effectiveness in randomised controlled trials had been implemented in community settings and were appropriate for people with differing levels of falls risk The programmes were the Otago Exercise Programme for people aged 65 and older or 80 and older Tai Chi Moving for Better Balance and Stepping On Analysis of the return on investment for these programmes showed that the benefits not only covered the implementation costs but also exceeded the expected direct medical costs4 ndash in other words these programmes prevented falls and provided a substantial return on investment
Home safety assessment and modification is effective for those at higher risk of falling
The 2012 Cochrane review on preventing falls in older people living in the community presents strong evidence from randomised controlled trials in the older age group that home safety assessment and modification programmes are effective in reducing falls particularly those at a higher risk of falling and when the programme is delivered by an occupational therapist
Multifactorial risk assessment and individualised interventions
Health professionals can ask older people about falls and injuries and work with them and their families to reduce the risk of falls and related injuries Although there are common risk factors in
the age group every older person is different and needs an individualised plan of care that addresses their particular risk factors through appropriate treatments and referrals
Short length of stay in acute care settings makes this approach more challenging but multifactorial interventions are effective for reducing the number of falls in older people living in the community
Workbook From Atlas to Action (2015 data) published March 2017 page 3
Key indicator summary for our DHB area and implications
Summary of data and responses from worksheets to inform planning
INDICATOR
1 ACC claims for fall-related injuries Nationally 217000 people aged 50 and older had an ACC claim for a fall-related injury accepted in 2015 People aged 85 and over were twice as likely to have an ACC claim for a fall-related injury and were 15 times more likely to be admitted to hospital as a result
Falls Atlas Indicator 1 key points for action from the data and questions
INDICATOR
3 Hospital admissions for fall-related injuries Nationally 20100 people aged 50 and older were admitted to hospital for more than one day due to a fall-related injury in 2015
Falls Atlas Indicator 3 key points for action from the data and questions
INDICATOR
5 Hip fracture due to a fallNationally 3600 people aged 50 and older had a fall-related hip fracture in 2015
Falls Atlas Indicator 5 key points for action from the data and questions
Implications from the data for our DHB area
Given the ageing population and the points noted above implications for planning and providing an integrated approach in our DHB area are as follows describe
Workbook From Atlas to Action (2015 data) published March 2017 page 4
IND
ICA
TOR
Worksheet People 50+ with one or more ACC claim for a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ with one or more ACC claims
Nationally 26 percent of those aged 85 and older have at least one ACC claim for a fall each year What is the data in the age group table below telling us
Not all fall-related injuries are captured in this data set (ie not reported by patients not medically treated or not claimed for or more than one claim) What assumptions can we make about the rate of falls with injury What can we do to elicit better falls histories
Given the high incidence of falls with injury what is being done community-wide to reduce falls in the frail elderly Are there established programmes and referral pathways
What screening and interventions are undertaken routinely to reduce injury related to falling eg assessment of bone health for detection and treatment of osteoporosis
Our data breakdown and comparisons Compared to the national mean of 142 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher
Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 967Pacific 1037Asian 861All other ethnicities 1543
By age group in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 12565ndash74 years 13575ndash84 years 17985+ years 264
By gender in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 1565Male 1257
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 5
1
Workbook From Atlas to Action (2015 data) published March 2017 page 6
IND
ICA
TOR
People 50+ with one or more hospital admissions due to a fall
Indicator 3 (admissions for more than one day) has been selected for attention in this Workbook as a useful subset of all hospital admissions Indicator 2 includes admissions to emergency departments which may be influenced by factors such as availability of or access to after-hours primary care
Workbook From Atlas to Action (2015 data) published March 2017 page 7
2
IND
ICA
TOR
Worksheet People 50+ admitted for more than one day due to a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ admitted for more than one day due to a fall
This indicator only looks at one fall-related admission per person in a year Do we know how many people had more than one admission for a fall-related injury in a year
Older people admitted due to a fall are by definition at risk of falling and should have their risk factors assessed and addressed in an individualised care plan Is this reflected in the report on our quality and safety markers for falls
Do we know how well we addressed these patients risk factors ndash either as an inpatient or follow-up with GP andor other services For instance medicine use could be reviewed in hospital whereas optimising an older persons vision may be a post-discharge referral
Our data breakdown and comparisons Compared to the national mean of 131 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 76Pacific 79Asian 56All other ethnicities 147
By age group in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 4165ndash74 years 9475ndash84 years 2985+ years 872
By gender in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 156Male 104
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 8
3
Workbook From Atlas to Action (2015 data) published March 2017 page 9
IND
ICA
TOR Worksheet Average bed-days for people 50+ admitted with a fall (DHB of
domicile)
Our data what questions should we ask
In 2015 in our DHB area the average bed-days were number for people aged 50 and older admitted in relation to a fall
Patients admitted with a fall are at risk of further falls as an inpatient (and after discharge) ndash what processes are in place for assessing risk of falling and implementing individualised interventions
What measures are in place to ensure a safe environment and safe care for these and all inpatients Do we audit the safety of the environment in relation to falls
Does use of interim care schemes explain any of the observed variation
How much variation can be explained by severity of injury or frailty
Our data breakdown and comparisons Compared to the national mean of 103 bed-days our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Ethnicity (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Māori 67Pacific 76Asian 84All other ethnicities 106
By age group in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Age group (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
50ndash64 years 4565ndash74 years 875ndash84 years 11685+ years 14
By gender in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Gender (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Female 109Male 92
RESOURCES
Topic 4 Safe environment and safe care essential in preventing falls pdfApril audit How safe is the care environment today Word doc
Workbook From Atlas to Action (2015 data) published March 2017 page 10
4
Workbook From Atlas to Action (2015 data) published March 2017 page 11
IND
ICA
TOR
Worksheet Hip fracture 50+ due to a fall (DHB of domicile)
Our data what questions should we ask
In 2015 in our DHB area hip fractures related to a fall for people aged 50 and older were number Although those in the age group 85 and older make up only 5 percent of the total population nationally in 2015 they represented half of all hip fractures in those aged 50 and older
At least half of the people who break their hip have suffered a prior fragility fracture23 signalling the need for multifactorial interventions directed to reducing their risk of falling and reducing their risk of injury eg treating osteoporosis
What additional data do we have to answer these questions
How many hip fracture patients were previously admitted for a fall-related injury How many have had a previous fragility fracture or hip fracture How many were referred to a Fracture Liaison Service (or equivalent follow-up)
How well is the Fracture Liaison Service integrated with the DHB falls prevention programme
Our data breakdown and comparisons Compared to the national mean of 23 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By age group in our DHB area in 2015 fall-related hip fractures for people 50+ were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 0265ndash74 years 1175ndash84 years 5585+ years 231
By gender in our DHB area in 2015 fall-related hip fractures for people 50+ were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 31Male 15
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 12
5
IND
ICA
TOR Worksheet Percent hip fracture 50+ operated on the same or next day of
admission (DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of hip fractures related to a fall for people aged 50 and older were operated on the day of admission or the next day
The Australian and New Zealand Guideline for Hip Fracture Care recommends that surgery is carried out within 48 hours ie the same or next day following hip fracture
When interpreting this indicator it is important to remember there are a number of reasons why surgery might be delayed such as medical instability need for further investigation or resource constraints such as theatre availability
Looking at local data what are the most common reasons for surgery to be delayed for more than two days
To what extent can delayed surgery be explained by demands on acute theatre resources
What other factors are causing delay to surgery in our DHB Is there a fast-track pathway in place for acute hip fracture If not what are the barriers to
providing one
Our data breakdown and comparisons The percentage in our DHB area is what Compared to the national mean of 764 percent this
is statistically significantly lowerno differentsignificantly higher Compared to what percent in name a similar DHB area our percent is statistically significantly
lowerno differentsignificantly higher
By year 2013-15 in our DHB area percentage and count of hip fractures operated on the day of admission or the next day were
Year National mean Our DHB areaPercentage Count Percentage
2013 7162014 7442015 764
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 13
6
IND
ICA
TOR Worksheet Percent bisphosphonate on discharge following hip fracture
(DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensed a bisphosphonate within six months of discharge from a hospital admission with a hip fracture
A review of bone health is recommended following a hip fracture this includes considering the use of bisphosphonatesa Bisphosphonates are used to reduce bone density loss and are indicated for the prevention and treatment of osteoporosis There is also evidence that bisphosphonates can reduce the risk of osteoporotic fractures however they may not be appropriate for patients with renal failure or a life expectancy of less than two years
Bisphosphonates should be used in conjunction with other individualised falls prevention interventions such as exercise to improve balance and strength and home safety assessment and modifications
Do DHBs with orthogeriatric services andor closely linked Fracture Liaison Services have higher rates of prescribing than those who donrsquot have these services
To what extent do clinical factors such as renal failure or life expectancy judgement explain the rate of bisphosphonate use
Our data breakdown and comparisons Compared to the national mean of 212 percent what percent is statistically significantly
lowerno differentsignificantly higher Compared to the rate of what percent in name a similar DHB area our percent is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentage and count of bisphosphonate dispensing were
Year National mean Our DHB areaPercent Count Percent
2013 2862014 2092015 212
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfBoneCare 2020A systematic approach to hip fracture care and prevention for New Zealand published by Osteoporosis New ZealandStrategies to improve hip fracture prevention and care pdf ndash summarises Bone Care 2020 and provides a four-step check for your local review
a
Workbook From Atlas to Action (2015 data) published March 2017 page 14
7
IND
ICA
TOR Worksheet Percent vitamin D on discharge for hip fracture (DHB of
service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensedb vitamin D within six months of discharge from a hospital admission with a hip fracture
Because vitamin D is essential for bone health and muscle function assessment of risk of vitamin D deficiency is recommended for all older people Health professionals prescribing vitamin D supplements assess the individual and take into account any contraindications
The Atlas shows wide variations between DHBs in the use of vitamin D following hip fracture
Why are some DHBs consistently lower or higher than the national mean How do similar DHBs compare What might the ideal rate of vitamin D use be What might be barriers to increasing rates of prescribing and how might we address
them
Our data breakdown and comparisons Compared to the national mean of 682 percent our rate of what percent is statistically
significantly lowerno differentsignificantly higher Compared to the rate of figure percent in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentages and count of prescribed vitamin D supplement dispensing were
Year National mean Our DHB areaPercentage Count Percentage
2013 7242014 6792015 682
RESOURCESTopic 7 Vitamin D and falls what you need to know pdfThe Ministry of Health and Cancer Societyrsquos Consensus Statement on Vitamin D and Sun Exposure in New Zealand ACC information for prescribers in general practice teams and staff working in residential care
b This data is from the Pharmaceutical Collection which captures prescribed medicines dispensed in a community pharmacy This indicator does not reflect over-the-counter vitamin D supplement use or whether or not medicine was taken The national programme recommends that vitamin D supplements are prescribed by a health practitioner after assessment of the older persons vitamin D status
Workbook From Atlas to Action (2015 data) published March 2017 page 15
8
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
Key indicator summary for our DHB area and implications
Summary of data and responses from worksheets to inform planning
INDICATOR
1 ACC claims for fall-related injuries Nationally 217000 people aged 50 and older had an ACC claim for a fall-related injury accepted in 2015 People aged 85 and over were twice as likely to have an ACC claim for a fall-related injury and were 15 times more likely to be admitted to hospital as a result
Falls Atlas Indicator 1 key points for action from the data and questions
INDICATOR
3 Hospital admissions for fall-related injuries Nationally 20100 people aged 50 and older were admitted to hospital for more than one day due to a fall-related injury in 2015
Falls Atlas Indicator 3 key points for action from the data and questions
INDICATOR
5 Hip fracture due to a fallNationally 3600 people aged 50 and older had a fall-related hip fracture in 2015
Falls Atlas Indicator 5 key points for action from the data and questions
Implications from the data for our DHB area
Given the ageing population and the points noted above implications for planning and providing an integrated approach in our DHB area are as follows describe
Workbook From Atlas to Action (2015 data) published March 2017 page 4
IND
ICA
TOR
Worksheet People 50+ with one or more ACC claim for a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ with one or more ACC claims
Nationally 26 percent of those aged 85 and older have at least one ACC claim for a fall each year What is the data in the age group table below telling us
Not all fall-related injuries are captured in this data set (ie not reported by patients not medically treated or not claimed for or more than one claim) What assumptions can we make about the rate of falls with injury What can we do to elicit better falls histories
Given the high incidence of falls with injury what is being done community-wide to reduce falls in the frail elderly Are there established programmes and referral pathways
What screening and interventions are undertaken routinely to reduce injury related to falling eg assessment of bone health for detection and treatment of osteoporosis
Our data breakdown and comparisons Compared to the national mean of 142 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher
Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 967Pacific 1037Asian 861All other ethnicities 1543
By age group in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 12565ndash74 years 13575ndash84 years 17985+ years 264
By gender in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 1565Male 1257
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 5
1
Workbook From Atlas to Action (2015 data) published March 2017 page 6
IND
ICA
TOR
People 50+ with one or more hospital admissions due to a fall
Indicator 3 (admissions for more than one day) has been selected for attention in this Workbook as a useful subset of all hospital admissions Indicator 2 includes admissions to emergency departments which may be influenced by factors such as availability of or access to after-hours primary care
Workbook From Atlas to Action (2015 data) published March 2017 page 7
2
IND
ICA
TOR
Worksheet People 50+ admitted for more than one day due to a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ admitted for more than one day due to a fall
This indicator only looks at one fall-related admission per person in a year Do we know how many people had more than one admission for a fall-related injury in a year
Older people admitted due to a fall are by definition at risk of falling and should have their risk factors assessed and addressed in an individualised care plan Is this reflected in the report on our quality and safety markers for falls
Do we know how well we addressed these patients risk factors ndash either as an inpatient or follow-up with GP andor other services For instance medicine use could be reviewed in hospital whereas optimising an older persons vision may be a post-discharge referral
Our data breakdown and comparisons Compared to the national mean of 131 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 76Pacific 79Asian 56All other ethnicities 147
By age group in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 4165ndash74 years 9475ndash84 years 2985+ years 872
By gender in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 156Male 104
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 8
3
Workbook From Atlas to Action (2015 data) published March 2017 page 9
IND
ICA
TOR Worksheet Average bed-days for people 50+ admitted with a fall (DHB of
domicile)
Our data what questions should we ask
In 2015 in our DHB area the average bed-days were number for people aged 50 and older admitted in relation to a fall
Patients admitted with a fall are at risk of further falls as an inpatient (and after discharge) ndash what processes are in place for assessing risk of falling and implementing individualised interventions
What measures are in place to ensure a safe environment and safe care for these and all inpatients Do we audit the safety of the environment in relation to falls
Does use of interim care schemes explain any of the observed variation
How much variation can be explained by severity of injury or frailty
Our data breakdown and comparisons Compared to the national mean of 103 bed-days our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Ethnicity (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Māori 67Pacific 76Asian 84All other ethnicities 106
By age group in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Age group (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
50ndash64 years 4565ndash74 years 875ndash84 years 11685+ years 14
By gender in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Gender (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Female 109Male 92
RESOURCES
Topic 4 Safe environment and safe care essential in preventing falls pdfApril audit How safe is the care environment today Word doc
Workbook From Atlas to Action (2015 data) published March 2017 page 10
4
Workbook From Atlas to Action (2015 data) published March 2017 page 11
IND
ICA
TOR
Worksheet Hip fracture 50+ due to a fall (DHB of domicile)
Our data what questions should we ask
In 2015 in our DHB area hip fractures related to a fall for people aged 50 and older were number Although those in the age group 85 and older make up only 5 percent of the total population nationally in 2015 they represented half of all hip fractures in those aged 50 and older
At least half of the people who break their hip have suffered a prior fragility fracture23 signalling the need for multifactorial interventions directed to reducing their risk of falling and reducing their risk of injury eg treating osteoporosis
What additional data do we have to answer these questions
How many hip fracture patients were previously admitted for a fall-related injury How many have had a previous fragility fracture or hip fracture How many were referred to a Fracture Liaison Service (or equivalent follow-up)
How well is the Fracture Liaison Service integrated with the DHB falls prevention programme
Our data breakdown and comparisons Compared to the national mean of 23 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By age group in our DHB area in 2015 fall-related hip fractures for people 50+ were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 0265ndash74 years 1175ndash84 years 5585+ years 231
By gender in our DHB area in 2015 fall-related hip fractures for people 50+ were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 31Male 15
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 12
5
IND
ICA
TOR Worksheet Percent hip fracture 50+ operated on the same or next day of
admission (DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of hip fractures related to a fall for people aged 50 and older were operated on the day of admission or the next day
The Australian and New Zealand Guideline for Hip Fracture Care recommends that surgery is carried out within 48 hours ie the same or next day following hip fracture
When interpreting this indicator it is important to remember there are a number of reasons why surgery might be delayed such as medical instability need for further investigation or resource constraints such as theatre availability
Looking at local data what are the most common reasons for surgery to be delayed for more than two days
To what extent can delayed surgery be explained by demands on acute theatre resources
What other factors are causing delay to surgery in our DHB Is there a fast-track pathway in place for acute hip fracture If not what are the barriers to
providing one
Our data breakdown and comparisons The percentage in our DHB area is what Compared to the national mean of 764 percent this
is statistically significantly lowerno differentsignificantly higher Compared to what percent in name a similar DHB area our percent is statistically significantly
lowerno differentsignificantly higher
By year 2013-15 in our DHB area percentage and count of hip fractures operated on the day of admission or the next day were
Year National mean Our DHB areaPercentage Count Percentage
2013 7162014 7442015 764
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 13
6
IND
ICA
TOR Worksheet Percent bisphosphonate on discharge following hip fracture
(DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensed a bisphosphonate within six months of discharge from a hospital admission with a hip fracture
A review of bone health is recommended following a hip fracture this includes considering the use of bisphosphonatesa Bisphosphonates are used to reduce bone density loss and are indicated for the prevention and treatment of osteoporosis There is also evidence that bisphosphonates can reduce the risk of osteoporotic fractures however they may not be appropriate for patients with renal failure or a life expectancy of less than two years
Bisphosphonates should be used in conjunction with other individualised falls prevention interventions such as exercise to improve balance and strength and home safety assessment and modifications
Do DHBs with orthogeriatric services andor closely linked Fracture Liaison Services have higher rates of prescribing than those who donrsquot have these services
To what extent do clinical factors such as renal failure or life expectancy judgement explain the rate of bisphosphonate use
Our data breakdown and comparisons Compared to the national mean of 212 percent what percent is statistically significantly
lowerno differentsignificantly higher Compared to the rate of what percent in name a similar DHB area our percent is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentage and count of bisphosphonate dispensing were
Year National mean Our DHB areaPercent Count Percent
2013 2862014 2092015 212
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfBoneCare 2020A systematic approach to hip fracture care and prevention for New Zealand published by Osteoporosis New ZealandStrategies to improve hip fracture prevention and care pdf ndash summarises Bone Care 2020 and provides a four-step check for your local review
a
Workbook From Atlas to Action (2015 data) published March 2017 page 14
7
IND
ICA
TOR Worksheet Percent vitamin D on discharge for hip fracture (DHB of
service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensedb vitamin D within six months of discharge from a hospital admission with a hip fracture
Because vitamin D is essential for bone health and muscle function assessment of risk of vitamin D deficiency is recommended for all older people Health professionals prescribing vitamin D supplements assess the individual and take into account any contraindications
The Atlas shows wide variations between DHBs in the use of vitamin D following hip fracture
Why are some DHBs consistently lower or higher than the national mean How do similar DHBs compare What might the ideal rate of vitamin D use be What might be barriers to increasing rates of prescribing and how might we address
them
Our data breakdown and comparisons Compared to the national mean of 682 percent our rate of what percent is statistically
significantly lowerno differentsignificantly higher Compared to the rate of figure percent in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentages and count of prescribed vitamin D supplement dispensing were
Year National mean Our DHB areaPercentage Count Percentage
2013 7242014 6792015 682
RESOURCESTopic 7 Vitamin D and falls what you need to know pdfThe Ministry of Health and Cancer Societyrsquos Consensus Statement on Vitamin D and Sun Exposure in New Zealand ACC information for prescribers in general practice teams and staff working in residential care
b This data is from the Pharmaceutical Collection which captures prescribed medicines dispensed in a community pharmacy This indicator does not reflect over-the-counter vitamin D supplement use or whether or not medicine was taken The national programme recommends that vitamin D supplements are prescribed by a health practitioner after assessment of the older persons vitamin D status
Workbook From Atlas to Action (2015 data) published March 2017 page 15
8
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
IND
ICA
TOR
Worksheet People 50+ with one or more ACC claim for a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ with one or more ACC claims
Nationally 26 percent of those aged 85 and older have at least one ACC claim for a fall each year What is the data in the age group table below telling us
Not all fall-related injuries are captured in this data set (ie not reported by patients not medically treated or not claimed for or more than one claim) What assumptions can we make about the rate of falls with injury What can we do to elicit better falls histories
Given the high incidence of falls with injury what is being done community-wide to reduce falls in the frail elderly Are there established programmes and referral pathways
What screening and interventions are undertaken routinely to reduce injury related to falling eg assessment of bone health for detection and treatment of osteoporosis
Our data breakdown and comparisons Compared to the national mean of 142 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher
Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 967Pacific 1037Asian 861All other ethnicities 1543
By age group in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 12565ndash74 years 13575ndash84 years 17985+ years 264
By gender in our DHB area in 2015 people 50+ with one or more ACC claim for a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 1565Male 1257
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 5
1
Workbook From Atlas to Action (2015 data) published March 2017 page 6
IND
ICA
TOR
People 50+ with one or more hospital admissions due to a fall
Indicator 3 (admissions for more than one day) has been selected for attention in this Workbook as a useful subset of all hospital admissions Indicator 2 includes admissions to emergency departments which may be influenced by factors such as availability of or access to after-hours primary care
Workbook From Atlas to Action (2015 data) published March 2017 page 7
2
IND
ICA
TOR
Worksheet People 50+ admitted for more than one day due to a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ admitted for more than one day due to a fall
This indicator only looks at one fall-related admission per person in a year Do we know how many people had more than one admission for a fall-related injury in a year
Older people admitted due to a fall are by definition at risk of falling and should have their risk factors assessed and addressed in an individualised care plan Is this reflected in the report on our quality and safety markers for falls
Do we know how well we addressed these patients risk factors ndash either as an inpatient or follow-up with GP andor other services For instance medicine use could be reviewed in hospital whereas optimising an older persons vision may be a post-discharge referral
Our data breakdown and comparisons Compared to the national mean of 131 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 76Pacific 79Asian 56All other ethnicities 147
By age group in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 4165ndash74 years 9475ndash84 years 2985+ years 872
By gender in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 156Male 104
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 8
3
Workbook From Atlas to Action (2015 data) published March 2017 page 9
IND
ICA
TOR Worksheet Average bed-days for people 50+ admitted with a fall (DHB of
domicile)
Our data what questions should we ask
In 2015 in our DHB area the average bed-days were number for people aged 50 and older admitted in relation to a fall
Patients admitted with a fall are at risk of further falls as an inpatient (and after discharge) ndash what processes are in place for assessing risk of falling and implementing individualised interventions
What measures are in place to ensure a safe environment and safe care for these and all inpatients Do we audit the safety of the environment in relation to falls
Does use of interim care schemes explain any of the observed variation
How much variation can be explained by severity of injury or frailty
Our data breakdown and comparisons Compared to the national mean of 103 bed-days our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Ethnicity (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Māori 67Pacific 76Asian 84All other ethnicities 106
By age group in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Age group (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
50ndash64 years 4565ndash74 years 875ndash84 years 11685+ years 14
By gender in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Gender (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Female 109Male 92
RESOURCES
Topic 4 Safe environment and safe care essential in preventing falls pdfApril audit How safe is the care environment today Word doc
Workbook From Atlas to Action (2015 data) published March 2017 page 10
4
Workbook From Atlas to Action (2015 data) published March 2017 page 11
IND
ICA
TOR
Worksheet Hip fracture 50+ due to a fall (DHB of domicile)
Our data what questions should we ask
In 2015 in our DHB area hip fractures related to a fall for people aged 50 and older were number Although those in the age group 85 and older make up only 5 percent of the total population nationally in 2015 they represented half of all hip fractures in those aged 50 and older
At least half of the people who break their hip have suffered a prior fragility fracture23 signalling the need for multifactorial interventions directed to reducing their risk of falling and reducing their risk of injury eg treating osteoporosis
What additional data do we have to answer these questions
How many hip fracture patients were previously admitted for a fall-related injury How many have had a previous fragility fracture or hip fracture How many were referred to a Fracture Liaison Service (or equivalent follow-up)
How well is the Fracture Liaison Service integrated with the DHB falls prevention programme
Our data breakdown and comparisons Compared to the national mean of 23 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By age group in our DHB area in 2015 fall-related hip fractures for people 50+ were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 0265ndash74 years 1175ndash84 years 5585+ years 231
By gender in our DHB area in 2015 fall-related hip fractures for people 50+ were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 31Male 15
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 12
5
IND
ICA
TOR Worksheet Percent hip fracture 50+ operated on the same or next day of
admission (DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of hip fractures related to a fall for people aged 50 and older were operated on the day of admission or the next day
The Australian and New Zealand Guideline for Hip Fracture Care recommends that surgery is carried out within 48 hours ie the same or next day following hip fracture
When interpreting this indicator it is important to remember there are a number of reasons why surgery might be delayed such as medical instability need for further investigation or resource constraints such as theatre availability
Looking at local data what are the most common reasons for surgery to be delayed for more than two days
To what extent can delayed surgery be explained by demands on acute theatre resources
What other factors are causing delay to surgery in our DHB Is there a fast-track pathway in place for acute hip fracture If not what are the barriers to
providing one
Our data breakdown and comparisons The percentage in our DHB area is what Compared to the national mean of 764 percent this
is statistically significantly lowerno differentsignificantly higher Compared to what percent in name a similar DHB area our percent is statistically significantly
lowerno differentsignificantly higher
By year 2013-15 in our DHB area percentage and count of hip fractures operated on the day of admission or the next day were
Year National mean Our DHB areaPercentage Count Percentage
2013 7162014 7442015 764
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 13
6
IND
ICA
TOR Worksheet Percent bisphosphonate on discharge following hip fracture
(DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensed a bisphosphonate within six months of discharge from a hospital admission with a hip fracture
A review of bone health is recommended following a hip fracture this includes considering the use of bisphosphonatesa Bisphosphonates are used to reduce bone density loss and are indicated for the prevention and treatment of osteoporosis There is also evidence that bisphosphonates can reduce the risk of osteoporotic fractures however they may not be appropriate for patients with renal failure or a life expectancy of less than two years
Bisphosphonates should be used in conjunction with other individualised falls prevention interventions such as exercise to improve balance and strength and home safety assessment and modifications
Do DHBs with orthogeriatric services andor closely linked Fracture Liaison Services have higher rates of prescribing than those who donrsquot have these services
To what extent do clinical factors such as renal failure or life expectancy judgement explain the rate of bisphosphonate use
Our data breakdown and comparisons Compared to the national mean of 212 percent what percent is statistically significantly
lowerno differentsignificantly higher Compared to the rate of what percent in name a similar DHB area our percent is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentage and count of bisphosphonate dispensing were
Year National mean Our DHB areaPercent Count Percent
2013 2862014 2092015 212
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfBoneCare 2020A systematic approach to hip fracture care and prevention for New Zealand published by Osteoporosis New ZealandStrategies to improve hip fracture prevention and care pdf ndash summarises Bone Care 2020 and provides a four-step check for your local review
a
Workbook From Atlas to Action (2015 data) published March 2017 page 14
7
IND
ICA
TOR Worksheet Percent vitamin D on discharge for hip fracture (DHB of
service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensedb vitamin D within six months of discharge from a hospital admission with a hip fracture
Because vitamin D is essential for bone health and muscle function assessment of risk of vitamin D deficiency is recommended for all older people Health professionals prescribing vitamin D supplements assess the individual and take into account any contraindications
The Atlas shows wide variations between DHBs in the use of vitamin D following hip fracture
Why are some DHBs consistently lower or higher than the national mean How do similar DHBs compare What might the ideal rate of vitamin D use be What might be barriers to increasing rates of prescribing and how might we address
them
Our data breakdown and comparisons Compared to the national mean of 682 percent our rate of what percent is statistically
significantly lowerno differentsignificantly higher Compared to the rate of figure percent in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentages and count of prescribed vitamin D supplement dispensing were
Year National mean Our DHB areaPercentage Count Percentage
2013 7242014 6792015 682
RESOURCESTopic 7 Vitamin D and falls what you need to know pdfThe Ministry of Health and Cancer Societyrsquos Consensus Statement on Vitamin D and Sun Exposure in New Zealand ACC information for prescribers in general practice teams and staff working in residential care
b This data is from the Pharmaceutical Collection which captures prescribed medicines dispensed in a community pharmacy This indicator does not reflect over-the-counter vitamin D supplement use or whether or not medicine was taken The national programme recommends that vitamin D supplements are prescribed by a health practitioner after assessment of the older persons vitamin D status
Workbook From Atlas to Action (2015 data) published March 2017 page 15
8
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
Workbook From Atlas to Action (2015 data) published March 2017 page 6
IND
ICA
TOR
People 50+ with one or more hospital admissions due to a fall
Indicator 3 (admissions for more than one day) has been selected for attention in this Workbook as a useful subset of all hospital admissions Indicator 2 includes admissions to emergency departments which may be influenced by factors such as availability of or access to after-hours primary care
Workbook From Atlas to Action (2015 data) published March 2017 page 7
2
IND
ICA
TOR
Worksheet People 50+ admitted for more than one day due to a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ admitted for more than one day due to a fall
This indicator only looks at one fall-related admission per person in a year Do we know how many people had more than one admission for a fall-related injury in a year
Older people admitted due to a fall are by definition at risk of falling and should have their risk factors assessed and addressed in an individualised care plan Is this reflected in the report on our quality and safety markers for falls
Do we know how well we addressed these patients risk factors ndash either as an inpatient or follow-up with GP andor other services For instance medicine use could be reviewed in hospital whereas optimising an older persons vision may be a post-discharge referral
Our data breakdown and comparisons Compared to the national mean of 131 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 76Pacific 79Asian 56All other ethnicities 147
By age group in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 4165ndash74 years 9475ndash84 years 2985+ years 872
By gender in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 156Male 104
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 8
3
Workbook From Atlas to Action (2015 data) published March 2017 page 9
IND
ICA
TOR Worksheet Average bed-days for people 50+ admitted with a fall (DHB of
domicile)
Our data what questions should we ask
In 2015 in our DHB area the average bed-days were number for people aged 50 and older admitted in relation to a fall
Patients admitted with a fall are at risk of further falls as an inpatient (and after discharge) ndash what processes are in place for assessing risk of falling and implementing individualised interventions
What measures are in place to ensure a safe environment and safe care for these and all inpatients Do we audit the safety of the environment in relation to falls
Does use of interim care schemes explain any of the observed variation
How much variation can be explained by severity of injury or frailty
Our data breakdown and comparisons Compared to the national mean of 103 bed-days our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Ethnicity (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Māori 67Pacific 76Asian 84All other ethnicities 106
By age group in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Age group (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
50ndash64 years 4565ndash74 years 875ndash84 years 11685+ years 14
By gender in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Gender (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Female 109Male 92
RESOURCES
Topic 4 Safe environment and safe care essential in preventing falls pdfApril audit How safe is the care environment today Word doc
Workbook From Atlas to Action (2015 data) published March 2017 page 10
4
Workbook From Atlas to Action (2015 data) published March 2017 page 11
IND
ICA
TOR
Worksheet Hip fracture 50+ due to a fall (DHB of domicile)
Our data what questions should we ask
In 2015 in our DHB area hip fractures related to a fall for people aged 50 and older were number Although those in the age group 85 and older make up only 5 percent of the total population nationally in 2015 they represented half of all hip fractures in those aged 50 and older
At least half of the people who break their hip have suffered a prior fragility fracture23 signalling the need for multifactorial interventions directed to reducing their risk of falling and reducing their risk of injury eg treating osteoporosis
What additional data do we have to answer these questions
How many hip fracture patients were previously admitted for a fall-related injury How many have had a previous fragility fracture or hip fracture How many were referred to a Fracture Liaison Service (or equivalent follow-up)
How well is the Fracture Liaison Service integrated with the DHB falls prevention programme
Our data breakdown and comparisons Compared to the national mean of 23 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By age group in our DHB area in 2015 fall-related hip fractures for people 50+ were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 0265ndash74 years 1175ndash84 years 5585+ years 231
By gender in our DHB area in 2015 fall-related hip fractures for people 50+ were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 31Male 15
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 12
5
IND
ICA
TOR Worksheet Percent hip fracture 50+ operated on the same or next day of
admission (DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of hip fractures related to a fall for people aged 50 and older were operated on the day of admission or the next day
The Australian and New Zealand Guideline for Hip Fracture Care recommends that surgery is carried out within 48 hours ie the same or next day following hip fracture
When interpreting this indicator it is important to remember there are a number of reasons why surgery might be delayed such as medical instability need for further investigation or resource constraints such as theatre availability
Looking at local data what are the most common reasons for surgery to be delayed for more than two days
To what extent can delayed surgery be explained by demands on acute theatre resources
What other factors are causing delay to surgery in our DHB Is there a fast-track pathway in place for acute hip fracture If not what are the barriers to
providing one
Our data breakdown and comparisons The percentage in our DHB area is what Compared to the national mean of 764 percent this
is statistically significantly lowerno differentsignificantly higher Compared to what percent in name a similar DHB area our percent is statistically significantly
lowerno differentsignificantly higher
By year 2013-15 in our DHB area percentage and count of hip fractures operated on the day of admission or the next day were
Year National mean Our DHB areaPercentage Count Percentage
2013 7162014 7442015 764
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 13
6
IND
ICA
TOR Worksheet Percent bisphosphonate on discharge following hip fracture
(DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensed a bisphosphonate within six months of discharge from a hospital admission with a hip fracture
A review of bone health is recommended following a hip fracture this includes considering the use of bisphosphonatesa Bisphosphonates are used to reduce bone density loss and are indicated for the prevention and treatment of osteoporosis There is also evidence that bisphosphonates can reduce the risk of osteoporotic fractures however they may not be appropriate for patients with renal failure or a life expectancy of less than two years
Bisphosphonates should be used in conjunction with other individualised falls prevention interventions such as exercise to improve balance and strength and home safety assessment and modifications
Do DHBs with orthogeriatric services andor closely linked Fracture Liaison Services have higher rates of prescribing than those who donrsquot have these services
To what extent do clinical factors such as renal failure or life expectancy judgement explain the rate of bisphosphonate use
Our data breakdown and comparisons Compared to the national mean of 212 percent what percent is statistically significantly
lowerno differentsignificantly higher Compared to the rate of what percent in name a similar DHB area our percent is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentage and count of bisphosphonate dispensing were
Year National mean Our DHB areaPercent Count Percent
2013 2862014 2092015 212
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfBoneCare 2020A systematic approach to hip fracture care and prevention for New Zealand published by Osteoporosis New ZealandStrategies to improve hip fracture prevention and care pdf ndash summarises Bone Care 2020 and provides a four-step check for your local review
a
Workbook From Atlas to Action (2015 data) published March 2017 page 14
7
IND
ICA
TOR Worksheet Percent vitamin D on discharge for hip fracture (DHB of
service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensedb vitamin D within six months of discharge from a hospital admission with a hip fracture
Because vitamin D is essential for bone health and muscle function assessment of risk of vitamin D deficiency is recommended for all older people Health professionals prescribing vitamin D supplements assess the individual and take into account any contraindications
The Atlas shows wide variations between DHBs in the use of vitamin D following hip fracture
Why are some DHBs consistently lower or higher than the national mean How do similar DHBs compare What might the ideal rate of vitamin D use be What might be barriers to increasing rates of prescribing and how might we address
them
Our data breakdown and comparisons Compared to the national mean of 682 percent our rate of what percent is statistically
significantly lowerno differentsignificantly higher Compared to the rate of figure percent in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentages and count of prescribed vitamin D supplement dispensing were
Year National mean Our DHB areaPercentage Count Percentage
2013 7242014 6792015 682
RESOURCESTopic 7 Vitamin D and falls what you need to know pdfThe Ministry of Health and Cancer Societyrsquos Consensus Statement on Vitamin D and Sun Exposure in New Zealand ACC information for prescribers in general practice teams and staff working in residential care
b This data is from the Pharmaceutical Collection which captures prescribed medicines dispensed in a community pharmacy This indicator does not reflect over-the-counter vitamin D supplement use or whether or not medicine was taken The national programme recommends that vitamin D supplements are prescribed by a health practitioner after assessment of the older persons vitamin D status
Workbook From Atlas to Action (2015 data) published March 2017 page 15
8
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
IND
ICA
TOR
People 50+ with one or more hospital admissions due to a fall
Indicator 3 (admissions for more than one day) has been selected for attention in this Workbook as a useful subset of all hospital admissions Indicator 2 includes admissions to emergency departments which may be influenced by factors such as availability of or access to after-hours primary care
Workbook From Atlas to Action (2015 data) published March 2017 page 7
2
IND
ICA
TOR
Worksheet People 50+ admitted for more than one day due to a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ admitted for more than one day due to a fall
This indicator only looks at one fall-related admission per person in a year Do we know how many people had more than one admission for a fall-related injury in a year
Older people admitted due to a fall are by definition at risk of falling and should have their risk factors assessed and addressed in an individualised care plan Is this reflected in the report on our quality and safety markers for falls
Do we know how well we addressed these patients risk factors ndash either as an inpatient or follow-up with GP andor other services For instance medicine use could be reviewed in hospital whereas optimising an older persons vision may be a post-discharge referral
Our data breakdown and comparisons Compared to the national mean of 131 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 76Pacific 79Asian 56All other ethnicities 147
By age group in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 4165ndash74 years 9475ndash84 years 2985+ years 872
By gender in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 156Male 104
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 8
3
Workbook From Atlas to Action (2015 data) published March 2017 page 9
IND
ICA
TOR Worksheet Average bed-days for people 50+ admitted with a fall (DHB of
domicile)
Our data what questions should we ask
In 2015 in our DHB area the average bed-days were number for people aged 50 and older admitted in relation to a fall
Patients admitted with a fall are at risk of further falls as an inpatient (and after discharge) ndash what processes are in place for assessing risk of falling and implementing individualised interventions
What measures are in place to ensure a safe environment and safe care for these and all inpatients Do we audit the safety of the environment in relation to falls
Does use of interim care schemes explain any of the observed variation
How much variation can be explained by severity of injury or frailty
Our data breakdown and comparisons Compared to the national mean of 103 bed-days our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Ethnicity (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Māori 67Pacific 76Asian 84All other ethnicities 106
By age group in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Age group (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
50ndash64 years 4565ndash74 years 875ndash84 years 11685+ years 14
By gender in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Gender (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Female 109Male 92
RESOURCES
Topic 4 Safe environment and safe care essential in preventing falls pdfApril audit How safe is the care environment today Word doc
Workbook From Atlas to Action (2015 data) published March 2017 page 10
4
Workbook From Atlas to Action (2015 data) published March 2017 page 11
IND
ICA
TOR
Worksheet Hip fracture 50+ due to a fall (DHB of domicile)
Our data what questions should we ask
In 2015 in our DHB area hip fractures related to a fall for people aged 50 and older were number Although those in the age group 85 and older make up only 5 percent of the total population nationally in 2015 they represented half of all hip fractures in those aged 50 and older
At least half of the people who break their hip have suffered a prior fragility fracture23 signalling the need for multifactorial interventions directed to reducing their risk of falling and reducing their risk of injury eg treating osteoporosis
What additional data do we have to answer these questions
How many hip fracture patients were previously admitted for a fall-related injury How many have had a previous fragility fracture or hip fracture How many were referred to a Fracture Liaison Service (or equivalent follow-up)
How well is the Fracture Liaison Service integrated with the DHB falls prevention programme
Our data breakdown and comparisons Compared to the national mean of 23 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By age group in our DHB area in 2015 fall-related hip fractures for people 50+ were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 0265ndash74 years 1175ndash84 years 5585+ years 231
By gender in our DHB area in 2015 fall-related hip fractures for people 50+ were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 31Male 15
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 12
5
IND
ICA
TOR Worksheet Percent hip fracture 50+ operated on the same or next day of
admission (DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of hip fractures related to a fall for people aged 50 and older were operated on the day of admission or the next day
The Australian and New Zealand Guideline for Hip Fracture Care recommends that surgery is carried out within 48 hours ie the same or next day following hip fracture
When interpreting this indicator it is important to remember there are a number of reasons why surgery might be delayed such as medical instability need for further investigation or resource constraints such as theatre availability
Looking at local data what are the most common reasons for surgery to be delayed for more than two days
To what extent can delayed surgery be explained by demands on acute theatre resources
What other factors are causing delay to surgery in our DHB Is there a fast-track pathway in place for acute hip fracture If not what are the barriers to
providing one
Our data breakdown and comparisons The percentage in our DHB area is what Compared to the national mean of 764 percent this
is statistically significantly lowerno differentsignificantly higher Compared to what percent in name a similar DHB area our percent is statistically significantly
lowerno differentsignificantly higher
By year 2013-15 in our DHB area percentage and count of hip fractures operated on the day of admission or the next day were
Year National mean Our DHB areaPercentage Count Percentage
2013 7162014 7442015 764
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 13
6
IND
ICA
TOR Worksheet Percent bisphosphonate on discharge following hip fracture
(DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensed a bisphosphonate within six months of discharge from a hospital admission with a hip fracture
A review of bone health is recommended following a hip fracture this includes considering the use of bisphosphonatesa Bisphosphonates are used to reduce bone density loss and are indicated for the prevention and treatment of osteoporosis There is also evidence that bisphosphonates can reduce the risk of osteoporotic fractures however they may not be appropriate for patients with renal failure or a life expectancy of less than two years
Bisphosphonates should be used in conjunction with other individualised falls prevention interventions such as exercise to improve balance and strength and home safety assessment and modifications
Do DHBs with orthogeriatric services andor closely linked Fracture Liaison Services have higher rates of prescribing than those who donrsquot have these services
To what extent do clinical factors such as renal failure or life expectancy judgement explain the rate of bisphosphonate use
Our data breakdown and comparisons Compared to the national mean of 212 percent what percent is statistically significantly
lowerno differentsignificantly higher Compared to the rate of what percent in name a similar DHB area our percent is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentage and count of bisphosphonate dispensing were
Year National mean Our DHB areaPercent Count Percent
2013 2862014 2092015 212
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfBoneCare 2020A systematic approach to hip fracture care and prevention for New Zealand published by Osteoporosis New ZealandStrategies to improve hip fracture prevention and care pdf ndash summarises Bone Care 2020 and provides a four-step check for your local review
a
Workbook From Atlas to Action (2015 data) published March 2017 page 14
7
IND
ICA
TOR Worksheet Percent vitamin D on discharge for hip fracture (DHB of
service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensedb vitamin D within six months of discharge from a hospital admission with a hip fracture
Because vitamin D is essential for bone health and muscle function assessment of risk of vitamin D deficiency is recommended for all older people Health professionals prescribing vitamin D supplements assess the individual and take into account any contraindications
The Atlas shows wide variations between DHBs in the use of vitamin D following hip fracture
Why are some DHBs consistently lower or higher than the national mean How do similar DHBs compare What might the ideal rate of vitamin D use be What might be barriers to increasing rates of prescribing and how might we address
them
Our data breakdown and comparisons Compared to the national mean of 682 percent our rate of what percent is statistically
significantly lowerno differentsignificantly higher Compared to the rate of figure percent in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentages and count of prescribed vitamin D supplement dispensing were
Year National mean Our DHB areaPercentage Count Percentage
2013 7242014 6792015 682
RESOURCESTopic 7 Vitamin D and falls what you need to know pdfThe Ministry of Health and Cancer Societyrsquos Consensus Statement on Vitamin D and Sun Exposure in New Zealand ACC information for prescribers in general practice teams and staff working in residential care
b This data is from the Pharmaceutical Collection which captures prescribed medicines dispensed in a community pharmacy This indicator does not reflect over-the-counter vitamin D supplement use or whether or not medicine was taken The national programme recommends that vitamin D supplements are prescribed by a health practitioner after assessment of the older persons vitamin D status
Workbook From Atlas to Action (2015 data) published March 2017 page 15
8
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
IND
ICA
TOR
Worksheet People 50+ admitted for more than one day due to a fall
Our data what questions should we ask
In 2015 in our DHB area there were number people 50+ admitted for more than one day due to a fall
This indicator only looks at one fall-related admission per person in a year Do we know how many people had more than one admission for a fall-related injury in a year
Older people admitted due to a fall are by definition at risk of falling and should have their risk factors assessed and addressed in an individualised care plan Is this reflected in the report on our quality and safety markers for falls
Do we know how well we addressed these patients risk factors ndash either as an inpatient or follow-up with GP andor other services For instance medicine use could be reviewed in hospital whereas optimising an older persons vision may be a post-discharge referral
Our data breakdown and comparisons Compared to the national mean of 131 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Ethnicity (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Māori 76Pacific 79Asian 56All other ethnicities 147
By age group in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 4165ndash74 years 9475ndash84 years 2985+ years 872
By gender in our DHB area in 2015 people 50+ admitted for more than one day due to a fall were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 156Male 104
RESOURCESAsk assess act project and resources Topic 2 Which older person is at risk of falling Ask assess act pdfTopic 3 Falls risk assessment and care planning what really matters pdf Topic 5 After a fall what should happen pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 8
3
Workbook From Atlas to Action (2015 data) published March 2017 page 9
IND
ICA
TOR Worksheet Average bed-days for people 50+ admitted with a fall (DHB of
domicile)
Our data what questions should we ask
In 2015 in our DHB area the average bed-days were number for people aged 50 and older admitted in relation to a fall
Patients admitted with a fall are at risk of further falls as an inpatient (and after discharge) ndash what processes are in place for assessing risk of falling and implementing individualised interventions
What measures are in place to ensure a safe environment and safe care for these and all inpatients Do we audit the safety of the environment in relation to falls
Does use of interim care schemes explain any of the observed variation
How much variation can be explained by severity of injury or frailty
Our data breakdown and comparisons Compared to the national mean of 103 bed-days our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Ethnicity (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Māori 67Pacific 76Asian 84All other ethnicities 106
By age group in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Age group (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
50ndash64 years 4565ndash74 years 875ndash84 years 11685+ years 14
By gender in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Gender (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Female 109Male 92
RESOURCES
Topic 4 Safe environment and safe care essential in preventing falls pdfApril audit How safe is the care environment today Word doc
Workbook From Atlas to Action (2015 data) published March 2017 page 10
4
Workbook From Atlas to Action (2015 data) published March 2017 page 11
IND
ICA
TOR
Worksheet Hip fracture 50+ due to a fall (DHB of domicile)
Our data what questions should we ask
In 2015 in our DHB area hip fractures related to a fall for people aged 50 and older were number Although those in the age group 85 and older make up only 5 percent of the total population nationally in 2015 they represented half of all hip fractures in those aged 50 and older
At least half of the people who break their hip have suffered a prior fragility fracture23 signalling the need for multifactorial interventions directed to reducing their risk of falling and reducing their risk of injury eg treating osteoporosis
What additional data do we have to answer these questions
How many hip fracture patients were previously admitted for a fall-related injury How many have had a previous fragility fracture or hip fracture How many were referred to a Fracture Liaison Service (or equivalent follow-up)
How well is the Fracture Liaison Service integrated with the DHB falls prevention programme
Our data breakdown and comparisons Compared to the national mean of 23 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By age group in our DHB area in 2015 fall-related hip fractures for people 50+ were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 0265ndash74 years 1175ndash84 years 5585+ years 231
By gender in our DHB area in 2015 fall-related hip fractures for people 50+ were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 31Male 15
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 12
5
IND
ICA
TOR Worksheet Percent hip fracture 50+ operated on the same or next day of
admission (DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of hip fractures related to a fall for people aged 50 and older were operated on the day of admission or the next day
The Australian and New Zealand Guideline for Hip Fracture Care recommends that surgery is carried out within 48 hours ie the same or next day following hip fracture
When interpreting this indicator it is important to remember there are a number of reasons why surgery might be delayed such as medical instability need for further investigation or resource constraints such as theatre availability
Looking at local data what are the most common reasons for surgery to be delayed for more than two days
To what extent can delayed surgery be explained by demands on acute theatre resources
What other factors are causing delay to surgery in our DHB Is there a fast-track pathway in place for acute hip fracture If not what are the barriers to
providing one
Our data breakdown and comparisons The percentage in our DHB area is what Compared to the national mean of 764 percent this
is statistically significantly lowerno differentsignificantly higher Compared to what percent in name a similar DHB area our percent is statistically significantly
lowerno differentsignificantly higher
By year 2013-15 in our DHB area percentage and count of hip fractures operated on the day of admission or the next day were
Year National mean Our DHB areaPercentage Count Percentage
2013 7162014 7442015 764
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 13
6
IND
ICA
TOR Worksheet Percent bisphosphonate on discharge following hip fracture
(DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensed a bisphosphonate within six months of discharge from a hospital admission with a hip fracture
A review of bone health is recommended following a hip fracture this includes considering the use of bisphosphonatesa Bisphosphonates are used to reduce bone density loss and are indicated for the prevention and treatment of osteoporosis There is also evidence that bisphosphonates can reduce the risk of osteoporotic fractures however they may not be appropriate for patients with renal failure or a life expectancy of less than two years
Bisphosphonates should be used in conjunction with other individualised falls prevention interventions such as exercise to improve balance and strength and home safety assessment and modifications
Do DHBs with orthogeriatric services andor closely linked Fracture Liaison Services have higher rates of prescribing than those who donrsquot have these services
To what extent do clinical factors such as renal failure or life expectancy judgement explain the rate of bisphosphonate use
Our data breakdown and comparisons Compared to the national mean of 212 percent what percent is statistically significantly
lowerno differentsignificantly higher Compared to the rate of what percent in name a similar DHB area our percent is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentage and count of bisphosphonate dispensing were
Year National mean Our DHB areaPercent Count Percent
2013 2862014 2092015 212
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfBoneCare 2020A systematic approach to hip fracture care and prevention for New Zealand published by Osteoporosis New ZealandStrategies to improve hip fracture prevention and care pdf ndash summarises Bone Care 2020 and provides a four-step check for your local review
a
Workbook From Atlas to Action (2015 data) published March 2017 page 14
7
IND
ICA
TOR Worksheet Percent vitamin D on discharge for hip fracture (DHB of
service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensedb vitamin D within six months of discharge from a hospital admission with a hip fracture
Because vitamin D is essential for bone health and muscle function assessment of risk of vitamin D deficiency is recommended for all older people Health professionals prescribing vitamin D supplements assess the individual and take into account any contraindications
The Atlas shows wide variations between DHBs in the use of vitamin D following hip fracture
Why are some DHBs consistently lower or higher than the national mean How do similar DHBs compare What might the ideal rate of vitamin D use be What might be barriers to increasing rates of prescribing and how might we address
them
Our data breakdown and comparisons Compared to the national mean of 682 percent our rate of what percent is statistically
significantly lowerno differentsignificantly higher Compared to the rate of figure percent in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentages and count of prescribed vitamin D supplement dispensing were
Year National mean Our DHB areaPercentage Count Percentage
2013 7242014 6792015 682
RESOURCESTopic 7 Vitamin D and falls what you need to know pdfThe Ministry of Health and Cancer Societyrsquos Consensus Statement on Vitamin D and Sun Exposure in New Zealand ACC information for prescribers in general practice teams and staff working in residential care
b This data is from the Pharmaceutical Collection which captures prescribed medicines dispensed in a community pharmacy This indicator does not reflect over-the-counter vitamin D supplement use or whether or not medicine was taken The national programme recommends that vitamin D supplements are prescribed by a health practitioner after assessment of the older persons vitamin D status
Workbook From Atlas to Action (2015 data) published March 2017 page 15
8
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
Workbook From Atlas to Action (2015 data) published March 2017 page 9
IND
ICA
TOR Worksheet Average bed-days for people 50+ admitted with a fall (DHB of
domicile)
Our data what questions should we ask
In 2015 in our DHB area the average bed-days were number for people aged 50 and older admitted in relation to a fall
Patients admitted with a fall are at risk of further falls as an inpatient (and after discharge) ndash what processes are in place for assessing risk of falling and implementing individualised interventions
What measures are in place to ensure a safe environment and safe care for these and all inpatients Do we audit the safety of the environment in relation to falls
Does use of interim care schemes explain any of the observed variation
How much variation can be explained by severity of injury or frailty
Our data breakdown and comparisons Compared to the national mean of 103 bed-days our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Ethnicity (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Māori 67Pacific 76Asian 84All other ethnicities 106
By age group in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Age group (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
50ndash64 years 4565ndash74 years 875ndash84 years 11685+ years 14
By gender in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Gender (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Female 109Male 92
RESOURCES
Topic 4 Safe environment and safe care essential in preventing falls pdfApril audit How safe is the care environment today Word doc
Workbook From Atlas to Action (2015 data) published March 2017 page 10
4
Workbook From Atlas to Action (2015 data) published March 2017 page 11
IND
ICA
TOR
Worksheet Hip fracture 50+ due to a fall (DHB of domicile)
Our data what questions should we ask
In 2015 in our DHB area hip fractures related to a fall for people aged 50 and older were number Although those in the age group 85 and older make up only 5 percent of the total population nationally in 2015 they represented half of all hip fractures in those aged 50 and older
At least half of the people who break their hip have suffered a prior fragility fracture23 signalling the need for multifactorial interventions directed to reducing their risk of falling and reducing their risk of injury eg treating osteoporosis
What additional data do we have to answer these questions
How many hip fracture patients were previously admitted for a fall-related injury How many have had a previous fragility fracture or hip fracture How many were referred to a Fracture Liaison Service (or equivalent follow-up)
How well is the Fracture Liaison Service integrated with the DHB falls prevention programme
Our data breakdown and comparisons Compared to the national mean of 23 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By age group in our DHB area in 2015 fall-related hip fractures for people 50+ were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 0265ndash74 years 1175ndash84 years 5585+ years 231
By gender in our DHB area in 2015 fall-related hip fractures for people 50+ were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 31Male 15
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 12
5
IND
ICA
TOR Worksheet Percent hip fracture 50+ operated on the same or next day of
admission (DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of hip fractures related to a fall for people aged 50 and older were operated on the day of admission or the next day
The Australian and New Zealand Guideline for Hip Fracture Care recommends that surgery is carried out within 48 hours ie the same or next day following hip fracture
When interpreting this indicator it is important to remember there are a number of reasons why surgery might be delayed such as medical instability need for further investigation or resource constraints such as theatre availability
Looking at local data what are the most common reasons for surgery to be delayed for more than two days
To what extent can delayed surgery be explained by demands on acute theatre resources
What other factors are causing delay to surgery in our DHB Is there a fast-track pathway in place for acute hip fracture If not what are the barriers to
providing one
Our data breakdown and comparisons The percentage in our DHB area is what Compared to the national mean of 764 percent this
is statistically significantly lowerno differentsignificantly higher Compared to what percent in name a similar DHB area our percent is statistically significantly
lowerno differentsignificantly higher
By year 2013-15 in our DHB area percentage and count of hip fractures operated on the day of admission or the next day were
Year National mean Our DHB areaPercentage Count Percentage
2013 7162014 7442015 764
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 13
6
IND
ICA
TOR Worksheet Percent bisphosphonate on discharge following hip fracture
(DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensed a bisphosphonate within six months of discharge from a hospital admission with a hip fracture
A review of bone health is recommended following a hip fracture this includes considering the use of bisphosphonatesa Bisphosphonates are used to reduce bone density loss and are indicated for the prevention and treatment of osteoporosis There is also evidence that bisphosphonates can reduce the risk of osteoporotic fractures however they may not be appropriate for patients with renal failure or a life expectancy of less than two years
Bisphosphonates should be used in conjunction with other individualised falls prevention interventions such as exercise to improve balance and strength and home safety assessment and modifications
Do DHBs with orthogeriatric services andor closely linked Fracture Liaison Services have higher rates of prescribing than those who donrsquot have these services
To what extent do clinical factors such as renal failure or life expectancy judgement explain the rate of bisphosphonate use
Our data breakdown and comparisons Compared to the national mean of 212 percent what percent is statistically significantly
lowerno differentsignificantly higher Compared to the rate of what percent in name a similar DHB area our percent is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentage and count of bisphosphonate dispensing were
Year National mean Our DHB areaPercent Count Percent
2013 2862014 2092015 212
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfBoneCare 2020A systematic approach to hip fracture care and prevention for New Zealand published by Osteoporosis New ZealandStrategies to improve hip fracture prevention and care pdf ndash summarises Bone Care 2020 and provides a four-step check for your local review
a
Workbook From Atlas to Action (2015 data) published March 2017 page 14
7
IND
ICA
TOR Worksheet Percent vitamin D on discharge for hip fracture (DHB of
service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensedb vitamin D within six months of discharge from a hospital admission with a hip fracture
Because vitamin D is essential for bone health and muscle function assessment of risk of vitamin D deficiency is recommended for all older people Health professionals prescribing vitamin D supplements assess the individual and take into account any contraindications
The Atlas shows wide variations between DHBs in the use of vitamin D following hip fracture
Why are some DHBs consistently lower or higher than the national mean How do similar DHBs compare What might the ideal rate of vitamin D use be What might be barriers to increasing rates of prescribing and how might we address
them
Our data breakdown and comparisons Compared to the national mean of 682 percent our rate of what percent is statistically
significantly lowerno differentsignificantly higher Compared to the rate of figure percent in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentages and count of prescribed vitamin D supplement dispensing were
Year National mean Our DHB areaPercentage Count Percentage
2013 7242014 6792015 682
RESOURCESTopic 7 Vitamin D and falls what you need to know pdfThe Ministry of Health and Cancer Societyrsquos Consensus Statement on Vitamin D and Sun Exposure in New Zealand ACC information for prescribers in general practice teams and staff working in residential care
b This data is from the Pharmaceutical Collection which captures prescribed medicines dispensed in a community pharmacy This indicator does not reflect over-the-counter vitamin D supplement use or whether or not medicine was taken The national programme recommends that vitamin D supplements are prescribed by a health practitioner after assessment of the older persons vitamin D status
Workbook From Atlas to Action (2015 data) published March 2017 page 15
8
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
IND
ICA
TOR Worksheet Average bed-days for people 50+ admitted with a fall (DHB of
domicile)
Our data what questions should we ask
In 2015 in our DHB area the average bed-days were number for people aged 50 and older admitted in relation to a fall
Patients admitted with a fall are at risk of further falls as an inpatient (and after discharge) ndash what processes are in place for assessing risk of falling and implementing individualised interventions
What measures are in place to ensure a safe environment and safe care for these and all inpatients Do we audit the safety of the environment in relation to falls
Does use of interim care schemes explain any of the observed variation
How much variation can be explained by severity of injury or frailty
Our data breakdown and comparisons Compared to the national mean of 103 bed-days our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By ethnicity in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Ethnicity (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Māori 67Pacific 76Asian 84All other ethnicities 106
By age group in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Age group (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
50ndash64 years 4565ndash74 years 875ndash84 years 11685+ years 14
By gender in our DHB area in 2015 average bed-days for people 50+ admitted with a fall were
Gender (2015) National mean Our DHB areaAverage bed-days Count Average bed-days
Female 109Male 92
RESOURCES
Topic 4 Safe environment and safe care essential in preventing falls pdfApril audit How safe is the care environment today Word doc
Workbook From Atlas to Action (2015 data) published March 2017 page 10
4
Workbook From Atlas to Action (2015 data) published March 2017 page 11
IND
ICA
TOR
Worksheet Hip fracture 50+ due to a fall (DHB of domicile)
Our data what questions should we ask
In 2015 in our DHB area hip fractures related to a fall for people aged 50 and older were number Although those in the age group 85 and older make up only 5 percent of the total population nationally in 2015 they represented half of all hip fractures in those aged 50 and older
At least half of the people who break their hip have suffered a prior fragility fracture23 signalling the need for multifactorial interventions directed to reducing their risk of falling and reducing their risk of injury eg treating osteoporosis
What additional data do we have to answer these questions
How many hip fracture patients were previously admitted for a fall-related injury How many have had a previous fragility fracture or hip fracture How many were referred to a Fracture Liaison Service (or equivalent follow-up)
How well is the Fracture Liaison Service integrated with the DHB falls prevention programme
Our data breakdown and comparisons Compared to the national mean of 23 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By age group in our DHB area in 2015 fall-related hip fractures for people 50+ were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 0265ndash74 years 1175ndash84 years 5585+ years 231
By gender in our DHB area in 2015 fall-related hip fractures for people 50+ were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 31Male 15
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 12
5
IND
ICA
TOR Worksheet Percent hip fracture 50+ operated on the same or next day of
admission (DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of hip fractures related to a fall for people aged 50 and older were operated on the day of admission or the next day
The Australian and New Zealand Guideline for Hip Fracture Care recommends that surgery is carried out within 48 hours ie the same or next day following hip fracture
When interpreting this indicator it is important to remember there are a number of reasons why surgery might be delayed such as medical instability need for further investigation or resource constraints such as theatre availability
Looking at local data what are the most common reasons for surgery to be delayed for more than two days
To what extent can delayed surgery be explained by demands on acute theatre resources
What other factors are causing delay to surgery in our DHB Is there a fast-track pathway in place for acute hip fracture If not what are the barriers to
providing one
Our data breakdown and comparisons The percentage in our DHB area is what Compared to the national mean of 764 percent this
is statistically significantly lowerno differentsignificantly higher Compared to what percent in name a similar DHB area our percent is statistically significantly
lowerno differentsignificantly higher
By year 2013-15 in our DHB area percentage and count of hip fractures operated on the day of admission or the next day were
Year National mean Our DHB areaPercentage Count Percentage
2013 7162014 7442015 764
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 13
6
IND
ICA
TOR Worksheet Percent bisphosphonate on discharge following hip fracture
(DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensed a bisphosphonate within six months of discharge from a hospital admission with a hip fracture
A review of bone health is recommended following a hip fracture this includes considering the use of bisphosphonatesa Bisphosphonates are used to reduce bone density loss and are indicated for the prevention and treatment of osteoporosis There is also evidence that bisphosphonates can reduce the risk of osteoporotic fractures however they may not be appropriate for patients with renal failure or a life expectancy of less than two years
Bisphosphonates should be used in conjunction with other individualised falls prevention interventions such as exercise to improve balance and strength and home safety assessment and modifications
Do DHBs with orthogeriatric services andor closely linked Fracture Liaison Services have higher rates of prescribing than those who donrsquot have these services
To what extent do clinical factors such as renal failure or life expectancy judgement explain the rate of bisphosphonate use
Our data breakdown and comparisons Compared to the national mean of 212 percent what percent is statistically significantly
lowerno differentsignificantly higher Compared to the rate of what percent in name a similar DHB area our percent is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentage and count of bisphosphonate dispensing were
Year National mean Our DHB areaPercent Count Percent
2013 2862014 2092015 212
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfBoneCare 2020A systematic approach to hip fracture care and prevention for New Zealand published by Osteoporosis New ZealandStrategies to improve hip fracture prevention and care pdf ndash summarises Bone Care 2020 and provides a four-step check for your local review
a
Workbook From Atlas to Action (2015 data) published March 2017 page 14
7
IND
ICA
TOR Worksheet Percent vitamin D on discharge for hip fracture (DHB of
service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensedb vitamin D within six months of discharge from a hospital admission with a hip fracture
Because vitamin D is essential for bone health and muscle function assessment of risk of vitamin D deficiency is recommended for all older people Health professionals prescribing vitamin D supplements assess the individual and take into account any contraindications
The Atlas shows wide variations between DHBs in the use of vitamin D following hip fracture
Why are some DHBs consistently lower or higher than the national mean How do similar DHBs compare What might the ideal rate of vitamin D use be What might be barriers to increasing rates of prescribing and how might we address
them
Our data breakdown and comparisons Compared to the national mean of 682 percent our rate of what percent is statistically
significantly lowerno differentsignificantly higher Compared to the rate of figure percent in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentages and count of prescribed vitamin D supplement dispensing were
Year National mean Our DHB areaPercentage Count Percentage
2013 7242014 6792015 682
RESOURCESTopic 7 Vitamin D and falls what you need to know pdfThe Ministry of Health and Cancer Societyrsquos Consensus Statement on Vitamin D and Sun Exposure in New Zealand ACC information for prescribers in general practice teams and staff working in residential care
b This data is from the Pharmaceutical Collection which captures prescribed medicines dispensed in a community pharmacy This indicator does not reflect over-the-counter vitamin D supplement use or whether or not medicine was taken The national programme recommends that vitamin D supplements are prescribed by a health practitioner after assessment of the older persons vitamin D status
Workbook From Atlas to Action (2015 data) published March 2017 page 15
8
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
Workbook From Atlas to Action (2015 data) published March 2017 page 11
IND
ICA
TOR
Worksheet Hip fracture 50+ due to a fall (DHB of domicile)
Our data what questions should we ask
In 2015 in our DHB area hip fractures related to a fall for people aged 50 and older were number Although those in the age group 85 and older make up only 5 percent of the total population nationally in 2015 they represented half of all hip fractures in those aged 50 and older
At least half of the people who break their hip have suffered a prior fragility fracture23 signalling the need for multifactorial interventions directed to reducing their risk of falling and reducing their risk of injury eg treating osteoporosis
What additional data do we have to answer these questions
How many hip fracture patients were previously admitted for a fall-related injury How many have had a previous fragility fracture or hip fracture How many were referred to a Fracture Liaison Service (or equivalent follow-up)
How well is the Fracture Liaison Service integrated with the DHB falls prevention programme
Our data breakdown and comparisons Compared to the national mean of 23 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By age group in our DHB area in 2015 fall-related hip fractures for people 50+ were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 0265ndash74 years 1175ndash84 years 5585+ years 231
By gender in our DHB area in 2015 fall-related hip fractures for people 50+ were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 31Male 15
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 12
5
IND
ICA
TOR Worksheet Percent hip fracture 50+ operated on the same or next day of
admission (DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of hip fractures related to a fall for people aged 50 and older were operated on the day of admission or the next day
The Australian and New Zealand Guideline for Hip Fracture Care recommends that surgery is carried out within 48 hours ie the same or next day following hip fracture
When interpreting this indicator it is important to remember there are a number of reasons why surgery might be delayed such as medical instability need for further investigation or resource constraints such as theatre availability
Looking at local data what are the most common reasons for surgery to be delayed for more than two days
To what extent can delayed surgery be explained by demands on acute theatre resources
What other factors are causing delay to surgery in our DHB Is there a fast-track pathway in place for acute hip fracture If not what are the barriers to
providing one
Our data breakdown and comparisons The percentage in our DHB area is what Compared to the national mean of 764 percent this
is statistically significantly lowerno differentsignificantly higher Compared to what percent in name a similar DHB area our percent is statistically significantly
lowerno differentsignificantly higher
By year 2013-15 in our DHB area percentage and count of hip fractures operated on the day of admission or the next day were
Year National mean Our DHB areaPercentage Count Percentage
2013 7162014 7442015 764
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 13
6
IND
ICA
TOR Worksheet Percent bisphosphonate on discharge following hip fracture
(DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensed a bisphosphonate within six months of discharge from a hospital admission with a hip fracture
A review of bone health is recommended following a hip fracture this includes considering the use of bisphosphonatesa Bisphosphonates are used to reduce bone density loss and are indicated for the prevention and treatment of osteoporosis There is also evidence that bisphosphonates can reduce the risk of osteoporotic fractures however they may not be appropriate for patients with renal failure or a life expectancy of less than two years
Bisphosphonates should be used in conjunction with other individualised falls prevention interventions such as exercise to improve balance and strength and home safety assessment and modifications
Do DHBs with orthogeriatric services andor closely linked Fracture Liaison Services have higher rates of prescribing than those who donrsquot have these services
To what extent do clinical factors such as renal failure or life expectancy judgement explain the rate of bisphosphonate use
Our data breakdown and comparisons Compared to the national mean of 212 percent what percent is statistically significantly
lowerno differentsignificantly higher Compared to the rate of what percent in name a similar DHB area our percent is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentage and count of bisphosphonate dispensing were
Year National mean Our DHB areaPercent Count Percent
2013 2862014 2092015 212
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfBoneCare 2020A systematic approach to hip fracture care and prevention for New Zealand published by Osteoporosis New ZealandStrategies to improve hip fracture prevention and care pdf ndash summarises Bone Care 2020 and provides a four-step check for your local review
a
Workbook From Atlas to Action (2015 data) published March 2017 page 14
7
IND
ICA
TOR Worksheet Percent vitamin D on discharge for hip fracture (DHB of
service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensedb vitamin D within six months of discharge from a hospital admission with a hip fracture
Because vitamin D is essential for bone health and muscle function assessment of risk of vitamin D deficiency is recommended for all older people Health professionals prescribing vitamin D supplements assess the individual and take into account any contraindications
The Atlas shows wide variations between DHBs in the use of vitamin D following hip fracture
Why are some DHBs consistently lower or higher than the national mean How do similar DHBs compare What might the ideal rate of vitamin D use be What might be barriers to increasing rates of prescribing and how might we address
them
Our data breakdown and comparisons Compared to the national mean of 682 percent our rate of what percent is statistically
significantly lowerno differentsignificantly higher Compared to the rate of figure percent in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentages and count of prescribed vitamin D supplement dispensing were
Year National mean Our DHB areaPercentage Count Percentage
2013 7242014 6792015 682
RESOURCESTopic 7 Vitamin D and falls what you need to know pdfThe Ministry of Health and Cancer Societyrsquos Consensus Statement on Vitamin D and Sun Exposure in New Zealand ACC information for prescribers in general practice teams and staff working in residential care
b This data is from the Pharmaceutical Collection which captures prescribed medicines dispensed in a community pharmacy This indicator does not reflect over-the-counter vitamin D supplement use or whether or not medicine was taken The national programme recommends that vitamin D supplements are prescribed by a health practitioner after assessment of the older persons vitamin D status
Workbook From Atlas to Action (2015 data) published March 2017 page 15
8
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
IND
ICA
TOR
Worksheet Hip fracture 50+ due to a fall (DHB of domicile)
Our data what questions should we ask
In 2015 in our DHB area hip fractures related to a fall for people aged 50 and older were number Although those in the age group 85 and older make up only 5 percent of the total population nationally in 2015 they represented half of all hip fractures in those aged 50 and older
At least half of the people who break their hip have suffered a prior fragility fracture23 signalling the need for multifactorial interventions directed to reducing their risk of falling and reducing their risk of injury eg treating osteoporosis
What additional data do we have to answer these questions
How many hip fracture patients were previously admitted for a fall-related injury How many have had a previous fragility fracture or hip fracture How many were referred to a Fracture Liaison Service (or equivalent follow-up)
How well is the Fracture Liaison Service integrated with the DHB falls prevention programme
Our data breakdown and comparisons Compared to the national mean of 23 per 1000 our rate of number is statistically significantly
lowerno differentsignificantly higher Compared to the rate of number per 1000 in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By age group in our DHB area in 2015 fall-related hip fractures for people 50+ were
Age group (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
50ndash64 years 0265ndash74 years 1175ndash84 years 5585+ years 231
By gender in our DHB area in 2015 fall-related hip fractures for people 50+ were
Gender (2015) National mean Our DHB areaRate per 1000 Count Rate per 1000
Female 31Male 15
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 12
5
IND
ICA
TOR Worksheet Percent hip fracture 50+ operated on the same or next day of
admission (DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of hip fractures related to a fall for people aged 50 and older were operated on the day of admission or the next day
The Australian and New Zealand Guideline for Hip Fracture Care recommends that surgery is carried out within 48 hours ie the same or next day following hip fracture
When interpreting this indicator it is important to remember there are a number of reasons why surgery might be delayed such as medical instability need for further investigation or resource constraints such as theatre availability
Looking at local data what are the most common reasons for surgery to be delayed for more than two days
To what extent can delayed surgery be explained by demands on acute theatre resources
What other factors are causing delay to surgery in our DHB Is there a fast-track pathway in place for acute hip fracture If not what are the barriers to
providing one
Our data breakdown and comparisons The percentage in our DHB area is what Compared to the national mean of 764 percent this
is statistically significantly lowerno differentsignificantly higher Compared to what percent in name a similar DHB area our percent is statistically significantly
lowerno differentsignificantly higher
By year 2013-15 in our DHB area percentage and count of hip fractures operated on the day of admission or the next day were
Year National mean Our DHB areaPercentage Count Percentage
2013 7162014 7442015 764
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 13
6
IND
ICA
TOR Worksheet Percent bisphosphonate on discharge following hip fracture
(DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensed a bisphosphonate within six months of discharge from a hospital admission with a hip fracture
A review of bone health is recommended following a hip fracture this includes considering the use of bisphosphonatesa Bisphosphonates are used to reduce bone density loss and are indicated for the prevention and treatment of osteoporosis There is also evidence that bisphosphonates can reduce the risk of osteoporotic fractures however they may not be appropriate for patients with renal failure or a life expectancy of less than two years
Bisphosphonates should be used in conjunction with other individualised falls prevention interventions such as exercise to improve balance and strength and home safety assessment and modifications
Do DHBs with orthogeriatric services andor closely linked Fracture Liaison Services have higher rates of prescribing than those who donrsquot have these services
To what extent do clinical factors such as renal failure or life expectancy judgement explain the rate of bisphosphonate use
Our data breakdown and comparisons Compared to the national mean of 212 percent what percent is statistically significantly
lowerno differentsignificantly higher Compared to the rate of what percent in name a similar DHB area our percent is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentage and count of bisphosphonate dispensing were
Year National mean Our DHB areaPercent Count Percent
2013 2862014 2092015 212
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfBoneCare 2020A systematic approach to hip fracture care and prevention for New Zealand published by Osteoporosis New ZealandStrategies to improve hip fracture prevention and care pdf ndash summarises Bone Care 2020 and provides a four-step check for your local review
a
Workbook From Atlas to Action (2015 data) published March 2017 page 14
7
IND
ICA
TOR Worksheet Percent vitamin D on discharge for hip fracture (DHB of
service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensedb vitamin D within six months of discharge from a hospital admission with a hip fracture
Because vitamin D is essential for bone health and muscle function assessment of risk of vitamin D deficiency is recommended for all older people Health professionals prescribing vitamin D supplements assess the individual and take into account any contraindications
The Atlas shows wide variations between DHBs in the use of vitamin D following hip fracture
Why are some DHBs consistently lower or higher than the national mean How do similar DHBs compare What might the ideal rate of vitamin D use be What might be barriers to increasing rates of prescribing and how might we address
them
Our data breakdown and comparisons Compared to the national mean of 682 percent our rate of what percent is statistically
significantly lowerno differentsignificantly higher Compared to the rate of figure percent in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentages and count of prescribed vitamin D supplement dispensing were
Year National mean Our DHB areaPercentage Count Percentage
2013 7242014 6792015 682
RESOURCESTopic 7 Vitamin D and falls what you need to know pdfThe Ministry of Health and Cancer Societyrsquos Consensus Statement on Vitamin D and Sun Exposure in New Zealand ACC information for prescribers in general practice teams and staff working in residential care
b This data is from the Pharmaceutical Collection which captures prescribed medicines dispensed in a community pharmacy This indicator does not reflect over-the-counter vitamin D supplement use or whether or not medicine was taken The national programme recommends that vitamin D supplements are prescribed by a health practitioner after assessment of the older persons vitamin D status
Workbook From Atlas to Action (2015 data) published March 2017 page 15
8
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
IND
ICA
TOR Worksheet Percent hip fracture 50+ operated on the same or next day of
admission (DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of hip fractures related to a fall for people aged 50 and older were operated on the day of admission or the next day
The Australian and New Zealand Guideline for Hip Fracture Care recommends that surgery is carried out within 48 hours ie the same or next day following hip fracture
When interpreting this indicator it is important to remember there are a number of reasons why surgery might be delayed such as medical instability need for further investigation or resource constraints such as theatre availability
Looking at local data what are the most common reasons for surgery to be delayed for more than two days
To what extent can delayed surgery be explained by demands on acute theatre resources
What other factors are causing delay to surgery in our DHB Is there a fast-track pathway in place for acute hip fracture If not what are the barriers to
providing one
Our data breakdown and comparisons The percentage in our DHB area is what Compared to the national mean of 764 percent this
is statistically significantly lowerno differentsignificantly higher Compared to what percent in name a similar DHB area our percent is statistically significantly
lowerno differentsignificantly higher
By year 2013-15 in our DHB area percentage and count of hip fractures operated on the day of admission or the next day were
Year National mean Our DHB areaPercentage Count Percentage
2013 7162014 7442015 764
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfStrategies to improve hip fracture prevention and care pdfAustralian and New Zealand Guideline for Hip Fracture Care pdf
Workbook From Atlas to Action (2015 data) published March 2017 page 13
6
IND
ICA
TOR Worksheet Percent bisphosphonate on discharge following hip fracture
(DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensed a bisphosphonate within six months of discharge from a hospital admission with a hip fracture
A review of bone health is recommended following a hip fracture this includes considering the use of bisphosphonatesa Bisphosphonates are used to reduce bone density loss and are indicated for the prevention and treatment of osteoporosis There is also evidence that bisphosphonates can reduce the risk of osteoporotic fractures however they may not be appropriate for patients with renal failure or a life expectancy of less than two years
Bisphosphonates should be used in conjunction with other individualised falls prevention interventions such as exercise to improve balance and strength and home safety assessment and modifications
Do DHBs with orthogeriatric services andor closely linked Fracture Liaison Services have higher rates of prescribing than those who donrsquot have these services
To what extent do clinical factors such as renal failure or life expectancy judgement explain the rate of bisphosphonate use
Our data breakdown and comparisons Compared to the national mean of 212 percent what percent is statistically significantly
lowerno differentsignificantly higher Compared to the rate of what percent in name a similar DHB area our percent is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentage and count of bisphosphonate dispensing were
Year National mean Our DHB areaPercent Count Percent
2013 2862014 2092015 212
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfBoneCare 2020A systematic approach to hip fracture care and prevention for New Zealand published by Osteoporosis New ZealandStrategies to improve hip fracture prevention and care pdf ndash summarises Bone Care 2020 and provides a four-step check for your local review
a
Workbook From Atlas to Action (2015 data) published March 2017 page 14
7
IND
ICA
TOR Worksheet Percent vitamin D on discharge for hip fracture (DHB of
service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensedb vitamin D within six months of discharge from a hospital admission with a hip fracture
Because vitamin D is essential for bone health and muscle function assessment of risk of vitamin D deficiency is recommended for all older people Health professionals prescribing vitamin D supplements assess the individual and take into account any contraindications
The Atlas shows wide variations between DHBs in the use of vitamin D following hip fracture
Why are some DHBs consistently lower or higher than the national mean How do similar DHBs compare What might the ideal rate of vitamin D use be What might be barriers to increasing rates of prescribing and how might we address
them
Our data breakdown and comparisons Compared to the national mean of 682 percent our rate of what percent is statistically
significantly lowerno differentsignificantly higher Compared to the rate of figure percent in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentages and count of prescribed vitamin D supplement dispensing were
Year National mean Our DHB areaPercentage Count Percentage
2013 7242014 6792015 682
RESOURCESTopic 7 Vitamin D and falls what you need to know pdfThe Ministry of Health and Cancer Societyrsquos Consensus Statement on Vitamin D and Sun Exposure in New Zealand ACC information for prescribers in general practice teams and staff working in residential care
b This data is from the Pharmaceutical Collection which captures prescribed medicines dispensed in a community pharmacy This indicator does not reflect over-the-counter vitamin D supplement use or whether or not medicine was taken The national programme recommends that vitamin D supplements are prescribed by a health practitioner after assessment of the older persons vitamin D status
Workbook From Atlas to Action (2015 data) published March 2017 page 15
8
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
IND
ICA
TOR Worksheet Percent bisphosphonate on discharge following hip fracture
(DHB of service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensed a bisphosphonate within six months of discharge from a hospital admission with a hip fracture
A review of bone health is recommended following a hip fracture this includes considering the use of bisphosphonatesa Bisphosphonates are used to reduce bone density loss and are indicated for the prevention and treatment of osteoporosis There is also evidence that bisphosphonates can reduce the risk of osteoporotic fractures however they may not be appropriate for patients with renal failure or a life expectancy of less than two years
Bisphosphonates should be used in conjunction with other individualised falls prevention interventions such as exercise to improve balance and strength and home safety assessment and modifications
Do DHBs with orthogeriatric services andor closely linked Fracture Liaison Services have higher rates of prescribing than those who donrsquot have these services
To what extent do clinical factors such as renal failure or life expectancy judgement explain the rate of bisphosphonate use
Our data breakdown and comparisons Compared to the national mean of 212 percent what percent is statistically significantly
lowerno differentsignificantly higher Compared to the rate of what percent in name a similar DHB area our percent is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentage and count of bisphosphonate dispensing were
Year National mean Our DHB areaPercent Count Percent
2013 2862014 2092015 212
RESOURCES
Topic 6 Why hip fracture prevention and care matters pdfBoneCare 2020A systematic approach to hip fracture care and prevention for New Zealand published by Osteoporosis New ZealandStrategies to improve hip fracture prevention and care pdf ndash summarises Bone Care 2020 and provides a four-step check for your local review
a
Workbook From Atlas to Action (2015 data) published March 2017 page 14
7
IND
ICA
TOR Worksheet Percent vitamin D on discharge for hip fracture (DHB of
service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensedb vitamin D within six months of discharge from a hospital admission with a hip fracture
Because vitamin D is essential for bone health and muscle function assessment of risk of vitamin D deficiency is recommended for all older people Health professionals prescribing vitamin D supplements assess the individual and take into account any contraindications
The Atlas shows wide variations between DHBs in the use of vitamin D following hip fracture
Why are some DHBs consistently lower or higher than the national mean How do similar DHBs compare What might the ideal rate of vitamin D use be What might be barriers to increasing rates of prescribing and how might we address
them
Our data breakdown and comparisons Compared to the national mean of 682 percent our rate of what percent is statistically
significantly lowerno differentsignificantly higher Compared to the rate of figure percent in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentages and count of prescribed vitamin D supplement dispensing were
Year National mean Our DHB areaPercentage Count Percentage
2013 7242014 6792015 682
RESOURCESTopic 7 Vitamin D and falls what you need to know pdfThe Ministry of Health and Cancer Societyrsquos Consensus Statement on Vitamin D and Sun Exposure in New Zealand ACC information for prescribers in general practice teams and staff working in residential care
b This data is from the Pharmaceutical Collection which captures prescribed medicines dispensed in a community pharmacy This indicator does not reflect over-the-counter vitamin D supplement use or whether or not medicine was taken The national programme recommends that vitamin D supplements are prescribed by a health practitioner after assessment of the older persons vitamin D status
Workbook From Atlas to Action (2015 data) published March 2017 page 15
8
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
IND
ICA
TOR Worksheet Percent vitamin D on discharge for hip fracture (DHB of
service)
Our data what questions should we ask
In 2015 in our DHB area what percentage of people aged 50 and older were dispensedb vitamin D within six months of discharge from a hospital admission with a hip fracture
Because vitamin D is essential for bone health and muscle function assessment of risk of vitamin D deficiency is recommended for all older people Health professionals prescribing vitamin D supplements assess the individual and take into account any contraindications
The Atlas shows wide variations between DHBs in the use of vitamin D following hip fracture
Why are some DHBs consistently lower or higher than the national mean How do similar DHBs compare What might the ideal rate of vitamin D use be What might be barriers to increasing rates of prescribing and how might we address
them
Our data breakdown and comparisons Compared to the national mean of 682 percent our rate of what percent is statistically
significantly lowerno differentsignificantly higher Compared to the rate of figure percent in name a similar DHB area our rate is statistically
significantly lowerno differentsignificantly higher
By year 2013ndash15 in our DHB area percentages and count of prescribed vitamin D supplement dispensing were
Year National mean Our DHB areaPercentage Count Percentage
2013 7242014 6792015 682
RESOURCESTopic 7 Vitamin D and falls what you need to know pdfThe Ministry of Health and Cancer Societyrsquos Consensus Statement on Vitamin D and Sun Exposure in New Zealand ACC information for prescribers in general practice teams and staff working in residential care
b This data is from the Pharmaceutical Collection which captures prescribed medicines dispensed in a community pharmacy This indicator does not reflect over-the-counter vitamin D supplement use or whether or not medicine was taken The national programme recommends that vitamin D supplements are prescribed by a health practitioner after assessment of the older persons vitamin D status
Workbook From Atlas to Action (2015 data) published March 2017 page 15
8
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
Tutorial using the bar chart to determine statistical significance
When looking at the bar chart we suggest you consider both what the ideal rate might be (eg what percentage of patients might you expect should receive bisphosphonates following a hip fracture) and also whether or not there might be variation in practice occurring at the local level (NB The examples below use 2013 data) This means that while it can be useful to know whether or not your DHB is significantly higher or
lower than the national average it is also important to consider the possibility of variation at the local level as well as whether at a national level there is variation from best practice
Since there is strong evidence for effective actions which prevent falls in older people and reduce harm from falls finding further scope for improvement is more important than comparisons
How to decide if a difference is significant
1 The national mean shows as you point over the red line at the left or right end
2 Pointing over the bar for your DHB area shows a window with a lower limit (LL) and upper limit (UL) which you can compare to the national mean The example below is for Wairarapa DHB
3 Use the expand button in the top right corner of the bar chart to expand the view
4 This means youll be able to see whiskers at the top of each bar showing lower and upper limits If the limits dont cross the mean there is a significant difference
Workbook From Atlas to Action (2015 data) published March 2017 page 16
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