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Abstract：
OBJECTIVE: To review the financial aspects of implementing the latest NICE guideline for neck of femur fracture (CG124), which recommends offering Total Hip Replacement (THR) as an alternative to hemiarthroplasty (HA) for patients, who are independently mobile before injury, not cognitively impaired and well enough to tolerate the operation.
METHODS: Between April 2011 and April 2013 data collected from our Hip Fracture database (NHFD) showed that by following the latest NICE guideline (CG124), out of 840 patients, 176 patients (21%) should be considered for THR rather than HA. Individual procedure costs were calculated by considering cost of implants and consumables (extracted from providers\' published catalogues) added to the cost of running operating theatre for each operation. We then used the national tariff for each procedure using relevant HRG codes to calculate the total cost and the income to the Trust.
RESULTS: Our data indicated that by implementing the latest NICE guideline (CG124), 37.1% of patients with intra-capsular fracture neck of femur (IC-NOF fracture) would be eligible for THR rather than HA. Although performing cemented THR was the more expensive procedure, our calculation shows that despite increased cost of performing the operation, Trusts can increase their net income by £300-600 (depending on their market force factor) per patient using correct HRG coding and National Tariff.
CONCLUSIONS: Utilising 2012-13 National Tariff, performing a cemented THR instead of a HA for patients with IC-NOF fracture, as recommended by the latest NICE guideline (CG124) can increase the Trust\'s revenue per patient in a predictable way. This practice not only results in potentially better patient outcomes but also can increase financial reward and potential for reinvestment in all hip fracture units in the UK.
METHODS: Between April 2011 and April 2013 data collected from our Hip Fracture database (NHFD) showed that by following the latest NICE guideline (CG124), out of 840 patients, 176 patients (21%) should be considered for THR rather than HA. Individual procedure costs were calculated by considering cost of implants and consumables (extracted from providers\' published catalogues) added to the cost of running operating theatre for each operation. We then used the national tariff for each procedure using relevant HRG codes to calculate the total cost and the income to the Trust.
RESULTS: Our data indicated that by implementing the latest NICE guideline (CG124), 37.1% of patients with intra-capsular fracture neck of femur (IC-NOF fracture) would be eligible for THR rather than HA. Although performing cemented THR was the more expensive procedure, our calculation shows that despite increased cost of performing the operation, Trusts can increase their net income by £300-600 (depending on their market force factor) per patient using correct HRG coding and National Tariff.
CONCLUSIONS: Utilising 2012-13 National Tariff, performing a cemented THR instead of a HA for patients with IC-NOF fracture, as recommended by the latest NICE guideline (CG124) can increase the Trust\'s revenue per patient in a predictable way. This practice not only results in potentially better patient outcomes but also can increase financial reward and potential for reinvestment in all hip fracture units in the UK.
摘要：
目的：回顾实施最新的NICE股骨颈骨折指南（CG124）的财务方面，建议为患者提供全髋关节置换术（THR）作为半髋关节置换术（HA）的替代方法，受伤前可以独立移动，没有认知障碍，足以忍受手术。
方法：2011年4月至2013年4月从我们的髋部骨折数据库（NHFD）收集的数据表明，通过遵循最新的NICE指南（CG124），在840名患者中，176名患者（21%）应考虑THR而不是HA。通过考虑将植入物和消耗品的成本（从提供者发布的目录中提取）添加到每个手术的运行手术室的成本来计算各个程序成本。然后，我们使用相关的HRG代码为每个程序使用国家关税来计算总成本和信托收入。
结果：我们的数据表明，通过实施最新的NICE指南（CG124），37.1％的股骨颈囊内骨折（IC-NOF骨折）患者符合THR而不是HA。虽然进行骨水泥THR是更昂贵的程序，我们的计算表明，尽管执行操作的成本增加，使用正确的HRG编码和国家关税，信托基金可以使每位患者的净收入增加300-600英镑（取决于其市场力量因素）。
结论：利用2012-13年度国家关税，对IC-NOF骨折患者进行骨水泥THR而不是HA，根据最新的NICE指南（CG124）的建议，可以以可预测的方式增加每位患者的Trust收入。这种做法不仅可能导致更好的患者结果，而且还可以增加财务回报和英国所有髋部骨折单位的再投资潜力。
方法：2011年4月至2013年4月从我们的髋部骨折数据库（NHFD）收集的数据表明，通过遵循最新的NICE指南（CG124），在840名患者中，176名患者（21%）应考虑THR而不是HA。通过考虑将植入物和消耗品的成本（从提供者发布的目录中提取）添加到每个手术的运行手术室的成本来计算各个程序成本。然后，我们使用相关的HRG代码为每个程序使用国家关税来计算总成本和信托收入。
结果：我们的数据表明，通过实施最新的NICE指南（CG124），37.1％的股骨颈囊内骨折（IC-NOF骨折）患者符合THR而不是HA。虽然进行骨水泥THR是更昂贵的程序，我们的计算表明，尽管执行操作的成本增加，使用正确的HRG编码和国家关税，信托基金可以使每位患者的净收入增加300-600英镑（取决于其市场力量因素）。
结论：利用2012-13年度国家关税，对IC-NOF骨折患者进行骨水泥THR而不是HA，根据最新的NICE指南（CG124）的建议，可以以可预测的方式增加每位患者的Trust收入。这种做法不仅可能导致更好的患者结果，而且还可以增加财务回报和英国所有髋部骨折单位的再投资潜力。
