• Pia Kjær Kristensen, Rikke Søgaard, Theis Muncholm Thillemann, Kjeld Søballe, and Søren Paaske Johnsen.
• Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N, Denmark.
• Int J Qual Health Care. 2019 Aug 1; 31 (7): 22-29.

ObjectiveTo examine whether fulfilment of process performance measures reflecting national guidelines is associated with in-hospital costs among hip fracture patients.DesignNationwide, population-based follow-up study.SettingPublic hospitals in Denmark.ParticipantsA total of 20 458 patients 65 years or older admitted with a hip fracture between 2010 and 2013.InterventionQuality of care defined as fulfilment of process performance measures reflecting recommendations from national clinical guidelines, which previously have been shown to be associated with lower mortality and readmission risk. The measures included systematic pain assessment; mobilisation within 24 h post-operatively; assessment of basic mobility before admission and discharge; and receiving a rehabilitation programme before discharge, anti-osteoporotic medication and fall prevention.Main Outcome MeasuresTotal costs defined as the sum of hospital costs used for treating the individual patients according to the Danish Reference Cost Database.ResultsWithin the index admission, fulfilling 50 to >75% of the performance measures was associated with lower adjusted costs (EUR 2643) than was fulfilling 0-50% of these measures (EUR 3544). The lower costs were mainly due to savings on further treatment and fewer bed days. Mobilisation within 24 h after surgery and assessment for need of anti-osteoporotic medication were associated with the largest cost differences, corresponding to adjusted cost differences of EUR 3030 and EUR 3538, respectively. The cost difference was lower when all costs related to hospitalisation within the first year were considered.ConclusionsThese findings indicate that high quality of care does not imply higher hospital spending and may be associated with cost savings.© The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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