England has highest death rates of older patients in western world, study finds
England has the highest death rates of frail and older hospitalised patients in the western world, a landmark global study has found.
Harvard University, the London School of Economics (LSE) and the thinktank Health Foundation, all part of the International Collaborative on Costs, Outcomes and Needs in Care (Icconic), a global network of healthcare researchers, used thousands of official medical records to compare the cost and quality of care in 10 OECD (Organisation for Economic Co-operation and Development) countries.
Patient deaths are commonly used measures of performance in healthcare systems but until now there have been few sources of comparable death rates across countries.
In order to assess outcomes in frail and older patients, researchers focused on two groups that represent priority areas for the NHS and other healthcare systems: those in hospital with a hip fracture and those admitted with heart failure who have diabetes.
On both measures, England had higher mortality rates than all the other countries, which included the US, Germany, France, Sweden and Spain. The data was analysed for patients aged 65 and over between 2014 and 2018 to provide an enhanced assessment of patient outcomes in the 10 countries.
One year after hip fracture surgery, almost a third (31%) of patients in England had died of any cause compared with less than a quarter of patients in Canada (23%) and Australia (22%). A year after being admitted to hospital with heart failure, more than four in 10 (43%) of diabetes patients in England had died. The next highest mortality rate was in the US (38%), followed by New Zealand (36%). France had the lowest death rates on both measures: 20% and 23% respectively.
High mortality among hip fracture patients is happening despite England performing well on other care quality measures. For example, 82% of hip fracture patients in England received surgery within 48 hours of admission, second only to Sweden, with 85% of patients. This is recommended as a key component of high-quality care. However, one year after their initial admission, 31% of English patients had died, compared with 25% of Swedish patients.
Another striking finding where England stands out from other countries in the Icconic study, is the length of time that hip fracture patients spent in hospital. Patients in England spent an average of 21.7 days in hospital after their initial surgery, the highest of all the 10 countries evaluated.
However, when it comes to financial outlay, England has among the lowest spending in primary care and secondary care on these patients, compared with the other countries. Only the Netherlands has lower overall spending. The findings provide evidence that while the NHS remains a relatively low-cost healthcare system performing well in many areas, death rates for some patients are higher than in comparable countries.Dr Jennifer Dixon, the chief executive of the Health Foundation, said: “The findings of the Icconic study warrant urgent further investigation, particularly the finding of higher mortality among patients with hip fracture in the year after their admission for emergency treatment.
“That patients in England with hip fracture spend far longer in hospital after surgery than they would in other countries also highlights an oppor
tunity to improve efficiency by reducing the avoidable use of hospital care. Less avoidably long stays would mean existing capacity could be better used to address the backlogs in hospital care as a result of the pandemic. This could contribute to both better outcomes for patients and, as hip fracture is the most common reason for emergency surgery, significantly improved productivity for hospitals across the country.”Dr Irene Papanicolas, associate professor of health economics at the LSE, added: “Further work is needed to understand what England can do to improve patient outcomes.”
An NHS source said there were many possible reasons for the differences in death rates seen between the 10 countries, including different local thresholds for hospital admission.
The source suggested that this is more likely to explain the variation in mortality for patients with heart failure and diabetes, where the extent to which patients are managed within the community versus hospital differs between countries.