Falls Analysis Fragility Fractures for patients aged 50 years and over (Using SEPHO ICD10 diagnosis definition) Draft v0.1 19 March 2011.

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Falls Analysis Fragility Fractures for patients aged 50 years and over (Using SEPHO ICD10 diagnosis definition) Draft v March 2011

Falls Analyses Contents: o F1.1.1(3) – In hospital mortality for people admitted with fragility fracture, by acute trust o F1.2.1(3) – Rate of secondary care admissions with fragility fracture, by acute trust o F1.2.2(3) – Standardised rate of secondary care admissions with fragility fracture, at a population level 2

F1.1.1(3) - In hospital mortality for people admitted with fragility fracture, by acute trust 3

F1.1.1(3) – In hospital mortality for people admitted with fragility fracture, by acute trust Table 1a: Observed number of deaths for for people admitted with fragility fracture (2008/09) Data source: HES 2008/09, 2009/10 4 Table 1b: Observed number of deaths for for people admitted with fragility fracture (2009/10) CodeProvider Name 2008/09 Q12008/09 Q22008/09 Q32008/09 Q42008/09 RLNCITY HOSPITALS SUNDERLAND NHS FOUNDATION TRUST RXPCOUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST RR7GATESHEAD HEALTH NHS FOUNDATION TRUST RVWNORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST RTFNORTHUMBRIA HEALTHCARE NHS FOUNDATION TRUST RTRSOUTH TEES HOSPITALS NHS TRUST RE9SOUTH TYNESIDE NHS FOUNDATION TRUST RTDTHE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST NORTH EAST CodeProvider Name 2009/10 Q12009/10 Q22009/10 Q32009/10 Q42009/10 RLNCITY HOSPITALS SUNDERLAND NHS FOUNDATION TRUST RXPCOUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST RR7GATESHEAD HEALTH NHS FOUNDATION TRUST RVWNORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST RTFNORTHUMBRIA HEALTHCARE NHS FOUNDATION TRUST RTRSOUTH TEES HOSPITALS NHS TRUST RE9SOUTH TYNESIDE NHS FOUNDATION TRUST RTDTHE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST NORTH EAST

5 Data source: HES 2008/09 Chart 1a: Standardised Mortality Ratio for people admitted with fragility fracture and 95% confidence intervals (2008/09) F1.1.1(3) – In hospital mortality for people admitted with fragility fracture, by acute trust

6 Data source: HES 2009/10 Chart 1b: Standardised Mortality Ratio for people admitted with fragility fracture and 95% confidence intervals (2009/10) F1.1.1(3) – In hospital mortality for people admitted with fragility fracture, by acute trust

7 Data source: HES 2008/09 Chart 2a: Funnel plot for SMR of people admitted with fragility fracture with 95% and 99.8% control limits (2008/09) F1.1.1(3) – In hospital mortality for people admitted with fragility fracture, by acute trust

8 Data source: HES 2009/10 Chart 2b: Funnel plot for SMR of people admitted with fragility fracture with 95% and 99.8% control limits (2009/10) F1.1.1(3) – In hospital mortality for people admitted with fragility fracture, by acute trust

F1.2.1(3) – Rate of secondary care admissions with fragility fracture, by acute trust 9

Table 1a: Observed number of secondary care admissions with fragility fracture (2008/09) Data source: HES 2008/09, 2009/10 10 Table 1b: Observed number of secondary care admissions with fragility fracture (2009/10) CodeProvider Name 2008/09 Q12008/09 Q22008/09 Q32008/09 Q42008/09 RLNCITY HOSPITALS SUNDERLAND NHS FOUNDATION TRUST RXPCOUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST RR7GATESHEAD HEALTH NHS FOUNDATION TRUST RVWNORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST RTFNORTHUMBRIA HEALTHCARE NHS FOUNDATION TRUST RTRSOUTH TEES HOSPITALS NHS TRUST RE9SOUTH TYNESIDE NHS FOUNDATION TRUST RTDTHE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST NORTH EAST CodeProvider Name 2009/10 Q12009/10 Q22009/10 Q32009/10 Q42009/10 RLNCITY HOSPITALS SUNDERLAND NHS FOUNDATION TRUST RXPCOUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST RR7GATESHEAD HEALTH NHS FOUNDATION TRUST RVWNORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST RTFNORTHUMBRIA HEALTHCARE NHS FOUNDATION TRUST RTRSOUTH TEES HOSPITALS NHS TRUST RE9SOUTH TYNESIDE NHS FOUNDATION TRUST RTDTHE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST NORTH EAST

F1.2.1(3) – Rate of secondary care admissions with fragility fracture, by acute trust Table 1a: Indirectly Standardised Ratio of secondary care admissions with fragility fracture (2008/09) Data source: HES 2008/09, 2009/10 11 Table 1b: Indirectly Standardised Ratio of secondary care admissions with fragility fracture (2009/10) CodeProvider Name 2008/09 Q12008/09 Q22008/09 Q32008/09 Q42008/09 RLNCITY HOSPITALS SUNDERLAND NHS FOUNDATION TRUST RXPCOUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST RR7GATESHEAD HEALTH NHS FOUNDATION TRUST RVWNORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST RTFNORTHUMBRIA HEALTHCARE NHS FOUNDATION TRUST RTRSOUTH TEES HOSPITALS NHS TRUST RE9SOUTH TYNESIDE NHS FOUNDATION TRUST RTDTHE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST CodeProvider Name 2009/10 Q12009/10 Q22009/10 Q32009/10 Q42009/10 RLNCITY HOSPITALS SUNDERLAND NHS FOUNDATION TRUST RXPCOUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST RR7GATESHEAD HEALTH NHS FOUNDATION TRUST RVWNORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST RTFNORTHUMBRIA HEALTHCARE NHS FOUNDATION TRUST RTRSOUTH TEES HOSPITALS NHS TRUST RE9SOUTH TYNESIDE NHS FOUNDATION TRUST RTDTHE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST

12 Data source: HES 2008/09 Chart 1a: Indirectly Standardised Ratio of secondary care admissions with fragility fracture and 95% confidence intervals (2008/09) F1.2.1(3) – Rate of secondary care admissions with fragility fracture, by acute trust

13 Data source: HES 2009/10 Chart 1a: Indirectly Standardised Ratio of secondary care admissions with fragility fracture and 95% confidence intervals (2009/10) F1.2.1(3) – Rate of secondary care admissions with fragility fracture, by acute trust

14 Data source: HES 2008/09 Chart 1a: Funnel plot for secondary care admissions with fragility fracture with 95% and 99.8% control limits (2008/09) F1.2.1(3) – Rate of secondary care admissions with fragility fracture, by acute trust

15 Data source: HES 2009/10 Chart 1b: Funnel plot for secondary care admissions with fragility fracture with 95% and 99.8% control limits (2009/10) F1.2.1(3) – Rate of secondary care admissions with fragility fracture, by acute trust

F1.2.2(3) – Standardised rate of secondary care admissions with fragility fracture, at a population level 16

F1.2.2(3) – Standardised rate of secondary care admissions with fragility fracture, at a population level Table 1a: Observed number of secondary care admissions with fragility fracture (2008/09) Data source: HES 2008/09 17 CodePCT Name 2008/09 Q12008/09 Q22008/09 Q32008/09 Q42008/09 5NDCOUNTY DURHAM PCT J9DARLINGTON PCT KFGATESHEAD PCT D9HARTLEPOOL PCT KMMIDDLESBROUGH PCT D7NEWCASTLE PCT D8NORTH TYNESIDE PCT TACNORTHUMBERLAND CARE TRUST QRREDCAR AND CLEVELAND PCT KGSOUTH TYNESIDE PCT E1STOCKTON-ON-TEES TEACHING PCT KLSUNDERLAND TEACHING PCT NORTH EAST

F1.2.2(3) – Standardised rate of secondary care admissions with fragility fracture, at a population level Table 1b: Observed number of secondary care admissions with fragility fracture (2009/10) Data source: HES 2009/10 18 CodePCT Name 2009/10 Q12009/10 Q22009/10 Q32009/10 Q42009/10 5NDCOUNTY DURHAM PCT J9DARLINGTON PCT KFGATESHEAD PCT D9HARTLEPOOL PCT KMMIDDLESBROUGH PCT D7NEWCASTLE PCT D8NORTH TYNESIDE PCT TACNORTHUMBERLAND CARE TRUST QRREDCAR AND CLEVELAND PCT KGSOUTH TYNESIDE PCT E1STOCKTON-ON-TEES TEACHING PCT KLSUNDERLAND TEACHING PCT NORTH EAST

F1.2.2(3) – Standardised rate of secondary care admissions with fragility fracture, at a population level Table 2a Directly Standardised Rate of secondary care admissions with fragility fracture per 100,000 population per year (2008/09) Data source: HES 2008/09 19 CodePCT Name 2008/09 Q12008/09 Q22008/09 Q32008/09 Q42008/09 5NDCOUNTY DURHAM PCT J9DARLINGTON PCT KFGATESHEAD PCT D9HARTLEPOOL PCT KMMIDDLESBROUGH PCT D7NEWCASTLE PCT D8NORTH TYNESIDE PCT TACNORTHUMBERLAND CARE TRUST QRREDCAR AND CLEVELAND PCT KGSOUTH TYNESIDE PCT E1STOCKTON-ON-TEES TEACHING PCT KLSUNDERLAND TEACHING PCT

F1.2.2(3) – Standardised rate of secondary care admissions with fragility fracture, at a population level Table 2b: Directly Standardised Rate of secondary care admissions with fragility fracture per 100,000 population per year (2009/10) Data source: HES 2009/10 20 CodePCT Name 2009/10 Q12009/10 Q22009/10 Q32009/10 Q42009/10 5NDCOUNTY DURHAM PCT J9DARLINGTON PCT KFGATESHEAD PCT D9HARTLEPOOL PCT KMMIDDLESBROUGH PCT D7NEWCASTLE PCT D8NORTH TYNESIDE PCT TACNORTHUMBERLAND CARE TRUST QRREDCAR AND CLEVELAND PCT KGSOUTH TYNESIDE PCT E1STOCKTON-ON-TEES TEACHING PCT KLSUNDERLAND TEACHING PCT

21 Data source: HES 2008/09 and ONS 2008 population estimates Chart 1a: Directly Standardised Rate of secondary care admissions with fragility fracture per 100,000 population and 95% confidence intervals (2008/09) F1.2.2(3) – Standardised rate of secondary care admissions with fragility fracture, at a population level

22 Data source: HES 2009/10 and ONS 2009 population estimates Chart 1b: Directly Standardised Rate of secondary care admissions with fragility fracture per 100,000 population and 95% confidence intervals (2009/10) F1.2.2(3) – Standardised rate of secondary care admissions with fragility fracture, at a population level

23 Data source: HES 2008/09 & 2009/10 and ONS 2008 & 2009 population estimates Chart 2: Time Series of Directly Standardised Rate of secondary care admissions with fragility fracture per 100,000 population F1.2.2(3) – Standardised rate of secondary care admissions with fragility fracture, at a population level

24 Data source: HES 2008/09 and ONS 2008 population estimates Chart 3a: Funnel plot of secondary care admissions with fragility fracture with 95% and 99.8% control limits (2008/09) F1.2.2(3) – Standardised rate of secondary care admissions with fragility fracture, at a population level

25 Data source: HES 2009/10 and ONS 2009 population estimates Chart 3b: Funnel plot of secondary care admissions with fragility fracture with 95% and 99.8% control limits (2009/10) F1.2.3(3) – Rate of secondary care admissions with fragility fracture of the proximal femur, by acute trust

Data Specifications 26

ICD10 Codes for Fragility Fractures 27 M48.4Fatigue fracture of vertebraS42.2Fracture of upper end of humerus M48.5Collapsed vertebra, not elsewhere classifiedS42.3Fracture of shaft of humerus M80.0Postmenopausal osteoporosis with pathological fractureS42.4Fracture of lower end of humerus M80.1Postoophorectomy osteoporosis with pathological fractureS52.0Fracture of upper end of ulna M80.2Osteoporosis of disuse with pathological fractureS52.1Fracture of upper end of radius M80.3Postsurgical malabsorption osteoporosis with path fractureS52.2Fracture of shaft of ulna M80.4Drug-induced osteoporosis with pathological fractureS52.3Fracture of shaft of radius M80.5Idiopathic osteoporosis with pathological fractureS52.4Fracture of shafts of both ulna and radius M80.8Other osteoporosis with pathological fractureS52.5Fracture of lower end of radius M80.9Unspecified osteoporosis with pathological fractureS52.6Fracture of lower end of both ulna and radius S22.0Fracture of thoracic vertebraS52.7Multiple fractures of forearm S22.1Multiple fractures of thoracic spineS62.0Fracture of navicular [scaphoid] bone of hand S32.0Fracture of lumbar vertebraS72.0Fracture of neck of femur S32.1Fracture of sacrumS72.1Pertrochanteric fracture S32.2 Fracture of coccyxS72.2Subtrochanteric fracture S32.3Fracture of iliumS72.3Fracture of shaft of femur S32.4Fracture of acetabulumT08.XFracture of spine, level unspecified S32.7Multiple fractures of lumbar spine and pelvis Data source: “Benchmarking quality of care for fragility fractures in the South Central SHA area”, October 2010, SEPHO.

F1.1.1(3) – In hospital mortality for people admitted with fragility fracture, by acute trust Data Source: HES data 2008/09, 2009/10 Data Details: Primary diagnosis recorded as fragility fracture for discharge episode (see ICD10 codes) Age at start of discharge episode greater or equal to 50 years old Admitted and discharged within year Discharge method equal to Death Indicator: Numerator: Number of secondary care admissions with fragility fracture where the patient died in hospital Denominator: All admissions with a primary diagnosis of fragility fracture Presentation: By acute trust Data Handling Notes: Indirectly standardised rate based on sex and age (5 year age bands from 50 to 89, and 90 and over) 28

F1.2.1(3) – Rate of secondary care admissions with fragility fracture, by acute trust Data Source: HES data 2008/09, 2009/10 Data Details: Primary diagnosis recorded as fragility fracture for discharge episode (see ICD10 codes) Age at start of discharge episode greater or equal to 50 years old Admitted and discharged within year Indicator: Numerator: Number of secondary care admissions with fragility fracture Denominator: All secondary care admissions Presentation: By acute trust Data Handling Notes: Indirectly standardised rate based on sex and age (5 year age bands from 50 to 89, and 90 and over ) 29

F1.2.2(3) – Standardised rate of secondary care admissions with fragility fracture, at a population level Data Source: HES data 2008/09, 2009/10 ONS population estimates 2008, 2009 Data Details: Primary diagnosis recorded as fragility fracture for discharge episode (see ICD10 codes) Age at start of discharge episode greater or equal to 50 years old Admitted and discharged within year Indicator: Numerator: Number of secondary care admissions with fragility fracture Denominator: PCT population Presentation: By PCT of residence Data Handling Notes: Directly standardised rate based on sex and age (5 year age bands from 50 to 84, and 85 and over) using WHO European standard age structure. 30