Spanish National Hip Fracture Registry (SNHFR): a description of its objectives, methodology and implementation

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the care of which involves an annual cost of 1&#44;591 million Euros and a loss of 7&#44;218 quality-adjusted life-years&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">4&#44;5</span></a> The incidence is expected to continue to increase in the near future&#44; especially among people over the age of 80 years&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Some factors in the care process of HF are known to influence its evolution and patients&#8217; clinical results&#46; Thus&#44; issues such as delay in surgical intervention&#44; lack of prevention and treatment of medical problems or the lack of early rehabilitation&#44; lead to a deterioration in the clinical course of patients and an increase in the final costs of the process&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Advances in terms of surgical technique&#44; types of anaesthesia&#44; perioperative care&#44; early rehabilitation and working in multidisciplinary teams have improved the clinical results&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">6&#44;7</span></a> Nevertheless&#44; the rates of mortality and of functional decline secondary to this type of fracture continue to be very high&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In recent years&#44; several articles and Clinical Practice Guidelines &#40;CPG&#41; have been published with recommendations that have enabled better care of and agreement around this condition&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">8&#8211;12</span></a> As has occurred previously in Great Britain with the publication of the <span class="elsevierStyleItalic">Blue Book</span> shared by several scientific societies of professionals who care for patients with hip fracture&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a> the <span class="elsevierStyleItalic">Clinical Practice Guidelines in Geriatrics for the Elderly Affected by Hip Fracture</span> was published in Spain in 2007 in collaboration with the Spanish Society of Geriatrics and Gerontology and the Spanish Society of Orthopaedic Surgery and Traumatology &#40;SEGG and SECOT&#59; Spanish acronyms&#41;&#44; as well as another CPG released in 2012 endorsed by the Spanish Association of Osteoporotic Fractures &#40;SEFRAOS&#59; Spanish acronym&#41;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">14&#44;15</span></a>&#46; But there has been no follow-up regarding their implementation in Spanish hospitals&#44; and the data available regarding clinical variability in the care of this process show large variability&#59; for example&#44; surgical delay&#44; length of hospital stay&#44; number of rehabilitation sessions&#44; availability of referral to a functional recovery unit&#44; number of physician follow-up visits or osteoporosis treatment rates&#44; among other aspects<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">4&#44;16&#44;17</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In several countries&#44; national registries have been set up for patients with HF&#46; Among these&#44; the most relevant are those undertaken in England&#44; Scotland and Australia&#46; These experiences and others have been summarised in recent publications&#44; observing that in the countries in which a HF registry has been undertaken&#44; the care process has been audited as a result&#44; inspecting whether it adheres to or deviates from the quality standards established and introducing corrective measures to improve the care process and efficiency<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">18&#44;19</span></a>&#46; For example&#44; after the implementation of the National Hip Fracture Database &#40;NHFD&#41; in England&#44; from 2007 to 2011 the percentage of patients who received surgery in the first 48<span class="elsevierStyleHsp" style=""></span>hours after admission increased from 54&#46;5&#37; to 71&#46;3&#37;&#44; mortality after 30 days decreased from 10&#46;9&#37; to 8&#46;5&#37; and early orthogeriatric intervention in patients admitted due to HF increased from 48&#37; to 90&#46;2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">20</span></a> Regarding efficiency&#44; there was also a reduction in hospital stay &#40;which is the process phase with the greatest consumption of resources&#41; and in institutionalization after discharge following implementation of the British NHFD registry&#46; A recent external evaluation has even shown an improvement in survival after 30&#44; 90 and 365 days&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">20</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Therefore&#44; the information provided by these registries is important for doctors and for managers&#46; Establishing and studying these registries provides an opportunity to work together auditing the process&#44; detecting any possible weaknesses in our services&#44; identifying areas for improvement&#44; and monitoring the impact of changes in clinical results and in management&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In Spain&#44; there have previously been registries and multicentre studies of great interest&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In the community of Castilla y Le&#243;n&#44; supported by the respective regional scientific societies of Geriatrics and Gerontology and of Orthopaedic Surgery and Traumatology&#44; orthogeriatric collaboration was assessed in the care of patients with HF admitted to 14 public hospitals in 2013&#59;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a> and subsequently&#44; in 2014 and 2015&#44; a temporary registry of hip fractures was developed for 2 months each year in the same hospitals&#46; Currently&#44; this registry has 776 cases&#59; the main findings have recently been published&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In recent years&#44; a multicentre study called SPARE-HIP was completed&#44; endorsed by the Spanish Society of Osteoporotic Fractures &#40;SEFRAOS&#59; Spanish acronym&#41;&#44; which involved studying a cohort of 30 cases of hip fracture each in 45 Spanish hospitals&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a> Its goal was to obtain a partial sample representative of the national territory&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Lastly&#44; Caeiro et al&#46; recently published another multicentre study that included 487 patients with HF admitted consecutively in 28 hospitals in 6 autonomous communities in Spain&#44; in order to find out the social and economic burden associated to fracture during hospitalization and 12 months afterwards&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">These registries are clearly of great interest because&#44; although each provides only a partial picture&#44; they compile considerable numbers of patients cared for at multiple sites in the Spanish territory and provide valuable information&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding the above&#44; the National Hip Fracture Registry &#40;NHFR&#59; RNFC&#44; Spanish acronym&#41;&#44; which is currently under way&#44; proposes improving some aspects&#44; namely&#44; 1&#41; consecutively including all patients diagnosed with HF at each participating hospital in a continuous registry and 2&#41; obtaining a comprehensive sample that can epidemiologically ensure representativeness on a national level&#44; with a final vocation for including all patients with HF who are hospitalized in the country&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Objectives</span><p id="par0065" class="elsevierStylePara elsevierViewall">The main objective of the NHFR is to ascertain the demographic&#44; clinical&#44; surgical&#44; functional and care-based characteristics of hip fracture patients throughout the Spanish territory&#44; during hospitalization and up to one month after hospital discharge&#44; analyse the presence and magnitude of the existing clinical variability and establish measures to improve care quality&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The secondary or specific objectives are&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0075" class="elsevierStylePara elsevierViewall">To ascertain the care model for the HF process in Spain and the variability in clinical practice between participating hospitals&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0080" class="elsevierStylePara elsevierViewall">To facilitate the evaluation of each site&#39;s results in terms of health and recovery of functional capacity for their patients&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">To audit practice comparing it to the recommendations of the current Clinical Practice Guidelines&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">To compare the results among the different participating Spanish hospitals with those of foreign hospitals included in the Fragility Fracture Network &#40;FFN&#41; database&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">To disclose the results among different participating hospitals and communicate them to the healthcare authorities and administrations&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">To establish explicit criteria for good in-process practices and results&#44; define the indicators for their measurement&#44; and propose concrete standards to be attained that specify excellent compliance to said indicators in order to improve care quality&#44; with imitation of best practice at the level of each hospital&#44; as well as regionally and nationally&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0105" class="elsevierStylePara elsevierViewall">To periodically audit the results obtained in the improvement of the process after implementing the registry and in the measures proposed seeking continuous improvement in care quality&#46;</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Method</span><p id="par0110" class="elsevierStylePara elsevierViewall">The registry will consist of a multicentre&#44; observational&#44; descriptive study of the epidemiological&#44; clinical and care characteristics obtained during admission&#44; inpatient evolution and one month after experiencing a HF due to fragility in a representative sample of&#44; initially&#44; 48 Spanish hospitals in the National Health Service network &#40;Annex 1&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The inclusion criteria are&#58; having been admitted to one of the participating hospitals with the diagnosis of hip fracture due to fragility &#40;due to a fall from standing height&#41;&#44; being older than 74 years of age &#40;75 years or older&#41; and understanding and signing an informed consent &#40;by the patient or their next of kin&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The exclusion criterion is any HF occurring as a result of high energy trauma as well as pathologic fractures due to cancer&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The variables to be collected include &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#58; age&#44; gender&#44; hospital&#44; autonomous community&#44; dates of admissions&#44; surgery and hospital discharge&#44; place of residence prior to admission&#44; at discharge and at one month&#44; prefracture patient mobility and mobility one month postfracture&#44; cognitive status at the time of admission &#40;Pfeiffer Questionnaire&#41;&#44; calcium and vitamin D supplements&#44; and anti-osteoporosis medication &#40;antiresorptive and osteoforming drugs&#41; prescribed to the patient prior to the fracture&#44; at hospital discharge and after one month&#44; the type of fracture&#44; the type of surgical intervention performed&#44; the anaesthetic risk &#40;ASA Classification&#41;&#44; the type of anaesthesia used during surgery&#44; the appearance of pressure ulcers during hospitalization&#44; their vital status at the time of hospital discharge and after one month&#44; the involvement of a clinical physician in addition to a specialist in Orthopaedic Surgery and Traumatology&#44; early postoperative mobilization &#40;in the first 24<span class="elsevierStyleHsp" style=""></span>hours after the intervention&#41;&#44; the length of hospital stay&#44; surgical delay&#44; as well as the the existence of surgical readmissions and surgical re-interventions in the month following the fracture&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">Data collection will be conducted using the Spanish version of the Fragility Fracture Network registry &#40;FFN Minimum Common Dataset - MCD&#41;&#46; The FFN &#40;Fragility Fracture Network&#41; is an international organization that aims to achieve maximum functional recovery and quality of life for people who have suffered an osteoporotic fracture&#44; as well as secondary prevention through the global optimization of the multidisciplinary management of this health problem&#46; Its activities include the creation of a network encompassing the greatest number of countries possible and the creation of Consensus Guidelines&#44; thus establishing quality standards and systematically measuring their application&#46; Within the FFN&#44; in 2013 members of an international working group composed mainly by representatives of other previously existing national registries&#44; proposed a Minimum Common Dataset &#40;FFN-MCD&#41; with three important characteristics&#58; it was concise&#44; it covered the key elements of the casemix&#44; care and results&#44; and it was compatible with already existing databases&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Data collection will take place in two phases&#46; In the hospital phase&#44; the data corresponding to baseline status and those referring to the process until the time of discharge will be collected by the physician in charge of the patient&#46; In the post-discharge phase&#44; data will be collected one month after the fracture by telephone interview or at a follow-up visit by the corresponding professional&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">There will be a representative at each participating hospital as the local person in charge of the registry&#44; responsible for sending data and safeguarding it&#46; The people in charge of each site will provide data on a quarterly basis for all the patients treated for a hip fracture at their hospital&#44; including follow-up one month after discharge&#46; The deadline for data inclusion will end 4 weeks after the end of each quarter&#46; The data sent will be encrypted&#44; and entered into an online platform for their analysis&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">A data manager will be in charge of assembling the data from all the hospitals&#44; assigning an identifier to each site that includes the autonomous community of origin&#44; data clean-up&#44; performing descriptive analyses and the pertinent associations&#44; drafting global quarterly reports &#40;of all the cases provided by the group of hospitals&#41; and global annual and partial reports &#40;by autonomous communities&#44; ACs&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Reports will be sent to the people in charge at each hospital&#44; to the representatives of the registry for each AC&#44; to the scientific societies that endorse it and to the sponsors&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Project Timeline &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Year prior to Registry &#40;already performed&#41;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Includes the definition of the project&#44; performing and publishing a literature review of the background of the subject&#44; the adaptation of the FFN Database&#44; coordination with the chairpersons in charge of the FFN registry&#44; request for endorsements by Scientific Societies&#44; the inclusion of hospitals and approval by Institutional Review Boards &#40;IRBs&#41;&#44; classification of the study by the Spanish Agency of Medicines and Medical Devices &#40;AEMPS&#41;&#44; request for support from the Ministry of Health &#40;General Sub-Directorate of Health Planning&#41;&#44; registry at the Spanish Agency of Data Protection&#44; and the integration of the Project in a Research Institute as the coordinating site &#40;Hospital Universitario La Paz Research Institute&#58; IdiPAZ&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">First year of Registry</span><p id="par0160" class="elsevierStylePara elsevierViewall">During the first quarter&#44; it is planned to hire Technical Secretary and Data Manager&#44; and to carry out the Pilot study at 15 hospitals&#44; and follow up with the collection of continuous data at the hospitals&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In the second half of the year&#44; data analysis should be carried out for the first 6 months&#44; and the first results are to be reported at national and international scientific meetings&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Second and third year of the Registry</span><p id="par0170" class="elsevierStylePara elsevierViewall">After the first complete year&#44; it is planned to carry out an annual analysis of the recorded data&#44; as well as an analysis of clinical variability in this period&#59; care quality standards&#44; criteria and indicators are to be defined&#44; updated ald followed up&#46; Data will be compared periodically among the ACs and compared to international data&#44; and the agreed-upon standards and results obtained thoughout the process of continuous quality improvement will be published&#46; Starting in the second year&#44; a request will be elevated to the Ministry of Health for the Registry to be considered as an Information Source of Health Interest&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Data analysis and exploitation</span><p id="par0175" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">1&#46;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Numeric and graphic descriptive statistics will be performed for the data from each participating hospital compared to the group and&#44; annually&#44; for the data grouped for each Autonomous Community and for all the cases nationally&#46; The descriptive statistics of each variable will use the mean &#40;and standard deviation&#41; or the median &#40;and interquartile ranges&#41; for the ordinal variables and the percentage for the qualitative variables&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">2&#46;</span><p id="par0185" class="elsevierStylePara elsevierViewall">A statistical analysis of variability will be carried out among sites&#58; Comparison of indicators using the Variation Rate &#40;VR75-25&#41; and Standardized Utilization Rate &#40;SUR&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">3&#46;</span><p id="par0190" class="elsevierStylePara elsevierViewall">The following are considered to be quality criteria for the definition of standards&#58; pre-surgical stay &#40;hours&#41;&#44; overall length of stay &#40;days&#41;&#44; percentage of patients managed surgically in the first 48<span class="elsevierStyleHsp" style=""></span>hours&#44; percentage of patients who mobilised in the first 24<span class="elsevierStyleHsp" style=""></span>hours after surgery&#44; percentage of patients treated during hospitalization by a clinical physician&#44; percentage of patients who develop pressure ulcers&#44; percentage of patients discharged with antiosteoporosis treatment &#40;secondary fracture prevention&#41;&#44; mortality rate during hospital admission and one month after the fracture&#44; degree of independence for ambulation one month after the fracture&#44; percentage of patients referred to functional recovery units&#44; percentage of patients with a new institutionalization &#40;admission to a nursing home among patients who previously lived in their home&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">4&#46;</span><p id="par0195" class="elsevierStylePara elsevierViewall">The investigators will propose quality standards based on the results of the hospitals with the best practices &#40;benchmarking&#41; and the Clinical Practice Guidelines and other international registries&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">5&#46;</span><p id="par0200" class="elsevierStylePara elsevierViewall">The quality thresholds will be expressed as a percentage of cases of each hospital that should comply with each of these standards&#46;</p></li></ul></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results analysis timeline</span><p id="par0205" class="elsevierStylePara elsevierViewall">The following will be performed during the first year&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">1&#46;</span><p id="par0210" class="elsevierStylePara elsevierViewall">Procurement of the results of the variables at each hospital&#44; each autonomous community and at a national level&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">2&#46;</span><p id="par0215" class="elsevierStylePara elsevierViewall">Comparison of the results with the rest of the countries participating in the international <span class="elsevierStyleItalic">Fragility Fracture Network</span> registry&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">3&#46;</span><p id="par0220" class="elsevierStylePara elsevierViewall">Definition of national standards and target-setting&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">During the second and third year&#44; the annual analyses described will be performed and&#44; additionally&#44;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">4&#46;</span><p id="par0230" class="elsevierStylePara elsevierViewall">Comparison of the annual evolution of each hospital for each one of the indicators established&#44; assessment of each hospital&#39;s internal capacity for improvement&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">5&#46;</span><p id="par0235" class="elsevierStylePara elsevierViewall">Assessment whether the implementation of the NHFR is able to improve the care process of fragility Hip Fractures in the elderly&#46;</p></li></ul></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Limitations and strengths of the NHFR</span><p id="par0240" class="elsevierStylePara elsevierViewall">The limitations of the Registry may be conditioned by the inherent nature of the study&#44; namely&#44; data collection by the healthcare professional who cares for the patient&#44; which could introduce biases on the one hand&#44; but on the other also provide added clinical value regarding other databases&#44; such as administrative ones&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">18</span></a> For pragmatic and economic reasons&#44; this is the manner in which data collection is being carried out in the international registries currently under way as&#44; otherwise&#44; costs for the project would be greatly increased&#46; It is unclear whether this fact may interfere negatively &#40;because of the aforementioned bias&#41; or positively &#40;by generating a quest for improvement in regular clinical activity&#41;&#46; To minimize this possible bias&#44; direct procurement of information electronically will be promoted whenever possible through hospital activity records and subsequently some variables available will be checked in the CMDB&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Another limitation is financial dependence to guarantee continued viability of the Project&#59; although no financial compensation is foreseen neither for the professionals who provide their cases&#44; nor for the people in charge at each hospital or for the investigating team&#44; it will be necessary to hire some professionals such as a data manager and technical secretary&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">The general strengths include the continuity of the registry&#44; as it will include all the patients hospitalized due to HF at each participating hospital&#44; and their demographic representativeness&#44; ensured by the large number of hospitals participating from the start and the desire to increase the number of hospitals&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">The strengths <span class="elsevierStyleItalic">inherent</span> to the study include the prior experience of the investigative team in the area approached by the Registry&#44; specifically their professional achievement in multidisciplinary coordinated treatment units &#40;Co-managed care&#41; for the care of patients with hip fracture&#44; the prior experience in the study and casemix analysis of hospital cohorts of patients with hip fracture&#44; the prior experience in coordination&#44; start-up and results analysis of the aforementioned Multicentre Hip Fracture Registries&#44; albeit more limited at a national level&#44; the previous experience of the team of epidemiologists in the initiation of longitudinal demographic epidemiological studies in the elderly population&#44; the recognition by the International Osteoporosis Foundation &#40;IOF&#41; of six of the Orthogeriatric units where research team members work as sites with Best Practices in Fractures Liaison Services &#40;FLS&#41; in Hip Fracture&#44; the scientific and educational contribution of the investigative team&#44; specifically regarding the subject of hip fracture&#44; which can be quantified in a total of 36 indexed articles on PubMed regarding aspects related to HF in the elderly&#44; in addition to several Doctoral Theses and a multitude of communications at congresses&#46; In addition to its own team of investigators&#44; the project includes the support of external &#8220;advisers&#8221; for assessment and methodological support by professionals of renowned prestige who have had responsibilities and accumulated experience through other hip fracture registries&#44; in addition to unite&#44; to date&#44; a total of 48 hospitals for the Project&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">extrinsic</span> strengths of the project include the following&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">-</span><p id="par0265" class="elsevierStylePara elsevierViewall">The NHFR has the initial support of the General Sub-Directorate of Health Promotion and Epidemiology of the Ministry of Health&#44; Social Services and Equality&#46;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">-</span><p id="par0270" class="elsevierStylePara elsevierViewall">It has been endorsed by chairpeople in charge of the Fragility Fracture Network &#40;FFN&#41; Hip Fracture International Registry&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">-</span><p id="par0275" class="elsevierStylePara elsevierViewall">It is backed by 18 national and regional Scientific Societies from the field of Geriatrics&#44; Traumatology and some multidisciplinary fields related to fractures and bone metabolism&#46; &#40;Annex 1&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">-</span><p id="par0280" class="elsevierStylePara elsevierViewall">It has been classified by the Spanish Agency of Medicines and Medical Devices &#40;AEMPS&#41; as Non-PAS &#40;a Non-Post-Authorization Study&#41;&#44; and therefore the administrative procedure that governs it only includes the approval or ratification of the respective Institutional Review Boards &#40;IRBs&#41; of each site&#46;</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">-</span><p id="par0285" class="elsevierStylePara elsevierViewall">It has been registered at the Spanish Agency for Data Protection&#46;</p></li></ul></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Distribution of tasks</span><p id="par0290" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel"><span class="elsevierStyleBold">-</span></span><p id="par0295" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">A representative from each hospital</span>&#58; responsible for the local registry&#44; including obtaining informed consent&#44; guarantee of proper data collection and inclusion of cases&#44; sending and safeguarding data&#46;</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel"><span class="elsevierStyleBold">-</span></span><p id="par0300" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Data manager&#58;</span> in charge of collecting and compiling the cases from all the sites&#44; data analysis and clean-up and drafting the results reports&#46;</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel"><span class="elsevierStyleBold">-</span></span><p id="par0305" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Technical secretary</span>&#58; in charge of coordinating information and managing the correspondence between the participating hospitals and the scientific societies backing the project&#44; achiving of documentation&#44; and drafting a newsletter with periodic updates for all the participating sites&#46;</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">-</span><p id="par0310" class="elsevierStylePara elsevierViewall">-The <span class="elsevierStyleBold">Investigative team</span> will develop the following functions&#58; design&#44; implementation&#44; follow-up&#44; protection and monitoring of data and the information generated by the Registry&#46; Coordination of the multicentre team&#46; Research and analysis duties &#40;direct or delegated to others requesting them&#41;&#46; Management and implementation of auditing duties&#44; definition of standards and proposal of objectives&#46; Continual results assessment&#46;</p></li></ul></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Current situation</span><p id="par0315" class="elsevierStylePara elsevierViewall">The NHFR currently has 3&#44;071 patient records from 48 hospitals&#44; two quarterly reports have been drafted and it has been presented at the following 2017 congresses&#58; Fragility Fracture Network &#40;FFN&#41;&#44; Spanish Society for Osteoporotic Fractures &#40;SEFRAOS&#41;&#44; Spanish Society for Geriatrics and Gerontology &#40;SEGG&#41;&#44; Spanish Society for Orthopaedic Surgery and Traumatology &#40;SECOT&#41;&#44; Madrid Society of Orthopaedic Surgery and Traumatology &#40;SOMACOT&#44; Spanish acronym&#41;&#44; and the Catalan Society of Geriatrics and Gerontology &#40;SCGIG&#44; Catalan acronym&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Call to potential participants</span><p id="par0320" class="elsevierStylePara elsevierViewall">This publication serves to communicate the NHFR&#39;s desire to include the greatest possible number of cases of patients with fragility hip fractures throughout the entire Spanish territory&#46; Physicians caring for patients with these characteristics can contact the Technical Secretariat at rnfc&#64;bsj-marketing&#46;es for their possible inclusion in the Registry&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Disclosure statement</span><p id="par0325" class="elsevierStylePara elsevierViewall">No potential conflicts of interest were disclosed&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To ascertain the current situation and clinical variability of the provision of care for Hip Fracture &#40;HF&#41; in Spain and the factors related to it by using a National Registry &#40;NHFR&#41; with high patient numbers and territorial representation NHFR&#44; and to compare results on a national and international level and propose standards and criteria to improve healthcare quality&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Continuous registry for at least three years of a representative sample of patients admitted to Spanish hospitals due to HF using the Minimum Common Dataset - international Fragility Fracture Network &#40;FFN&#41; MCD&#44; adapted for Spanish&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Study scope and subjects</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">all patients over the age of 74 years who are hospitalized with a diagnosis of a fragility HF at the participating hospitals distributed throughout the Spanish territory&#46; Initially 48 hospitals are included&#44; and we expect to incorporate the highest number of sites possible&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">It is expected to ascertain the current situation of provision of care for HF in Spain&#46; Each hospital will be offered information regarding their results and their situation compared to the rest&#46; The results from national hospitals will be compared to others included in the registry and to hospitals abroad&#44; which use the same database&#46; Variability will be studied&#44; care standards will be established&#44; and objectives will be proposed for the continuous improvement of the care process of this condition&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Conocer la situaci&#243;n actual y la variabilidad cl&#237;nica del proceso asistencial a la Fractura de Cadera &#40;FC&#41; en Espa&#241;a y los factores relacionados con la misma mediante la utilizaci&#243;n de un Registro Nacional &#40;RNFC&#41; con elevada casu&#237;stica y representaci&#243;n territorial RNFC&#44; as&#237; como comparar resultados en el &#225;mbito nacional e internacional y proponer est&#225;ndares y criterios para mejorar la calidad asistencial&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Dise&#241;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Registro continuo durante al menos tres a&#241;os de una muestra representativa de los pacientes ingresados por FC en los hospitales espa&#241;oles mediante el Minimum Common Dataset - MCD internacional de la Fragility Fracture Network &#40;FFN&#41; adaptado al castellano&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">&#193;mbito y sujetos del estudio</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">se incluir&#225;n todos los pacientes mayores de 74 a&#241;os hospitalizados con el diagn&#243;stico de FC por fragilidad en los hospitales participantes repartidos por el territorio espa&#241;ol&#46; Inicialmente est&#225;n incluidos 48 hospitales&#44; a los que se espera que se vayan incorporando el mayor n&#250;mero posible de centros&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se pretende conocer la situaci&#243;n actual de la atenci&#243;n a este proceso en Espa&#241;a Se ofrecer&#225; a cada hospital la informaci&#243;n de sus resultados y su situaci&#243;n en relaci&#243;n al resto&#44; se comparar&#225;n los resultados de los hospitales nacionales entre s&#237; y con los hospitales extranjeros incluidos en registros que usan la misma base de datos&#46; Se estudiar&#225; la variabilidad&#44; se establecer&#225;n est&#225;ndares asistenciales y se plantear&#225;n objetivos para la mejora continua del proceso en la atenci&#243;n a esta patolog&#237;a&#46;</p></span>"
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            "apendice" => "<p id="par0340" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Delegates for the National Scientific Societies</span></p> <p id="par0345" class="elsevierStylePara elsevierViewall">Manuel D&#237;az Curiel &#8211; Fundaci&#243;n Hispana de Osteoporosis y Enfermedades del Metabolismo &#211;seo &#40;Hispanic Foundation of Osteoporosis and Bone Metabolism Disorders&#44; FHOEMO&#41;&#46; Ricardo Larrainzar-Garijo &#8211; Sociedad Espa&#241;ola de Cirug&#237;a Ortop&#233;dica y Traumatolog&#237;a &#40;Spanisch Society of Orthopaedic Surgery and Traumatology&#44; SECOT&#41;&#46; Juan Ignacio Gonz&#225;lez Montalvo &#8211; Sociedad Espa&#241;ola de Fracturas Osteopor&#243;ticas &#40;Spanish Society of Osteoporotic Fractures&#44; SEFRAOS&#41;&#46; Alfonso Gonz&#225;lez Ram&#237;rez &#8211; Sociedad Espa&#241;ola de Geriatr&#237;a y Gerontolog&#237;a &#40;Spanish Society of Geriatrics and Gerontology&#44; SEGG&#41;&#46; Jos&#233; Ram&#243;n Caeiro &#8211; Sociedad Espa&#241;ola de Investigaci&#243;n &#211;sea y del Metabolismo Mineral &#40;Spanish Society of Bone and Mineral Metabolism Research&#44; SEIOMM&#41;&#46; Alfonso Gonz&#225;lez Ram&#237;rez &#8211; Sociedad Espa&#241;ola de Medicina Geri&#225;trica &#40;Spanish Society of Geriatric Medicine&#44; SEMEG&#41;&#46; Jose Luis P&#233;rez Castrill&#243;n &#8211; Sociedad Espa&#241;ola de Medicina Interna &#40;Spanish Society of Internal Medicine&#44; SEMI&#41;&#46;</p> <p id="par0350" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Delegates for the Regional Scientific Societies</span></p> <p id="par0355" class="elsevierStylePara elsevierViewall">Noelia Alonso Garc&#237;a &#8211; Sociedad Castellano Leonesa C&#225;ntabro y Riojana de Traumatolog&#237;a &#40;Society of Castille&#44; Leon&#44; Cantabria and Rioja of Traumatology&#59; SCLECARTO&#41;&#46; Pilar Mesa &#8211; Sociedad Aragonesa de Geriatr&#237;a y Gerontolog&#237;a &#40;Socity of Aragon of Geriatrics and Gerontology&#44; SAGGARAGON&#41;&#46; Ang&#233;lica Mu&#241;oz Pascual &#8211; Sociedad de Geriatr&#237;a y Gerontolog&#237;a de Castilla y Le&#243;n &#40;Society of Castille and Leon of Geriatrics and Gerontology&#44; SGGCYL&#41;&#46; Anabel Llopis &#8211; Sociedad Catalana de Geriatr&#237;a y Gerontolog&#237;a &#40;Society of Catalonia of Geriatrics and Gerontology&#44; SCGIG&#41;&#46; Raquel V&#225;llez &#8211; Sociedad Matritense de Cirug&#237;a Ortop&#233;dica y Traumatolog&#237;a &#40;Society of Madrid of Orthopedic Surgery and Traumatology&#44; SOMACOT&#41;&#46; Jes&#250;s Mora Fern&#225;ndez &#8211; Sociedad Madrile&#241;a de Geriatr&#237;a y Gerontolog&#237;a &#40;Society of Madrid of Geriatrics and Gerontology&#44; SMGG&#41;&#46; Francisco Tarazona &#8211; Sociedad Valenciana de Geriatr&#237;a y Gerontolog&#237;a Society of Valencia of Geriatrics and Gerontology&#44; &#40;SVGG&#41;&#46; Raquel Ort&#233;s &#8211; Sociedad Extreme&#241;a de Geriatr&#237;a y Gerontolog&#237;a &#40;Society of Extremadura of Geriatrics and Gerontology&#44; SOGGEX&#41;&#46; Teresa Pareja &#8211; Sociedad Castellano Manchega de Geriatr&#237;a y Gerontolog&#237;a &#40;Society of Castille-La Mancha of Geriatrics and Gerontology&#44; SCMGG&#41;&#46; Marta Alonso &#8211; Sociedad de Geriatr&#237;a y Gerontolog&#237;a del Principado de Asturias &#40;Society of the Principality of Asturias of Geriatrics and Gerontology&#44; SGGPA&#41;&#46; Jos&#233; Ram&#243;n Caeiro &#8211; Sociedad Gallega de Cirug&#237;a Ortop&#233;dica y Traumatolog&#237;a &#40;Society of Galicia of Orthopedic Surgery and Traumatology&#44; SOGACOT&#41;&#46; Vicente Canales &#8211; Sociedad Aragonesa de Cirug&#237;a Ortop&#233;dica y Traumatolog&#237;a &#40;Society of Aragon of Orthopedic Surgery and Traumatology&#44; SARCOT&#41;&#46; Pedro Carpintero &#8211; Sociedad Andaluza de Traumatolog&#237;a y Ortopedia &#40;Society of Andalusia of Orthopedic Surgery and Traumatology&#44; SATO&#41;&#46; In&#233;s Gil Broce&#241;o &#8211; Sociedad Murciana de Geriatr&#237;a y Gerontolog&#237;a &#40;Society of Murcia of Geriatrics and Gerontology&#44; SMGG&#41;&#46;</p> <p id="par0360" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Delegates for International Scientific Societies</span></p> <p id="par0365" class="elsevierStylePara elsevierViewall">Colin Currie &#8211; Fragility Fracture Network &#40;FFN&#41;&#46;</p> <p id="par0370" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Representatives for each of the participating hospitals</span></p> <p id="par0375" class="elsevierStylePara elsevierViewall">Sonia Jim&#233;nez Mola &#8211; Complejo Asistencial de Le&#243;n&#46; Mar&#237;a Cruz Mac&#237;as &#8211; Complejo Asistencial de Segovia&#46; Ana Andr&#233;s &#8211; Complejo Asistencial de Palencia&#46; Anabel Llopis &#8211; Hospital de Matar&#243; CSDM&#46; Pilar del Pozo Tagarro &#8211; Hospital Santos Reyes de Aranda de Duero&#46; Abelardo Montero S&#225;ez &#8211; Hospital Universitari de Bellvitge&#46; M&#170; Carmen Cervera - Hospital Cl&#237;nico Universitario de Valladolid&#46; Mariano de Miguel Artal &#8211; Hospital Universitario Santa Mar&#237;a &#47; Arnau de Vilanova de Lleida&#46; Cristina Rodriguez Gonz&#225;lez &#8211; Hospital de la Santa Creu de Jes&#250;s-Tortosa&#46; Francisco Su&#225;rez &#8211; Hospital Cruz Roja de Gij&#243;n&#46; Elena Ubis D&#237;ez &#8211; Hospital P&#250;blico Sagrado Coraz&#243;n de Jes&#250;s&#44; Huesca&#46; Francisco Jim&#233;nez Muela &#8211; Hospital Monte Naranco de Oviedo&#46; M&#170; Paz Garc&#237;a D&#237;az &#8211; Hospital de Barbastro&#46; Rebeca Fern&#225;ndez Regueiro &#8211; Hospital Universitario de Cabue&#241;es&#44; Gij&#243;n&#46; Pilar Mesa &#8211; Hospital Provincial de Nuestra Se&#241;ora de Gracia&#44; Zaragoza&#46; Jos&#233; Ram&#243;n Caeiro &#8211; Hospital Cl&#237;nico Universitario de Santiago de Compostela&#46; Guadalupe Lozano Pino &#8211; Hospital Virgen del Puerto de Plasencia&#46; Teresa Pareja &#8211; Hospital Universitario de Guadalajara&#46; &#193;ngel Castro Saura &#8211; Hospital Obispo Polanco de Teruel&#46; N&#250;ria Fern&#225;ndez Mart&#237;nez &#8211; Hospital General Universitario de Ciudad Real&#46; Raquel Bachiller &#8211; Hospital Universitario Nuestra Se&#241;ora de Candelaria de Tenerife&#46; Carmen Barrero Raya &#8211; Complejo Hospitalario de Toledo&#46; Nuria Montero Fern&#225;ndez &#8211; Hospital General Universitario Gregorio Mara&#241;&#243;n&#46; Natalia S&#225;nchez Hern&#225;ndez &#8211; Complejo Asistencial de &#193;vila&#46; F&#225;tima Bra&#241;as Bazt&#225;n &#8211; Hospital Universitario Infanta Leonor de Madrid&#46; Marta Neira &#193;lvarez &#8211; Hospital Universitario Infanta Sof&#237;a de Madrid&#46; Jes&#250;s Mora Fern&#225;ndez &#8211; Hospital Cl&#237;nico Universitario San Carlos de Madrid&#46; Marta P&#233;rez Garc&#237;a &#8211; Hospital &#193;lvaro Cunqueiro de Vigo&#46; Juan Ignacio Gonz&#225;lez Montalvo &#8211; Hospital Universitario La Paz de Madrid&#46; Raquel V&#225;llez &#8211; Hospital Central de la Defensa G&#243;mez Ulla de Madrid&#46; M&#170; Jes&#250;s Molina Hern&#225;ndez &#8211; Hospital Universitario Severo Ochoa de Legan&#233;s&#46; Julia Ill&#225;n &#8211; Hospital Universitario de Getafe&#44; Madrid&#46; Cristina Gonz&#225;lez de Villaumbros&#237;a &#8211; Hospital Rey Juan Carlos de M&#243;stoles&#44; Madrid&#46; Inmaculada Boyano &#8211; Hospital Universitario de M&#243;stoles&#44; Madrid&#46; Cristina Ojeda Thies &#8211; Hospital Universitario 12 de Octubre de Madrid&#46; Isabel P&#233;rez Mill&#225;n &#8211; Hospital Universitario Ram&#243;n y Cajal de Madrid&#46; Jos&#233; Salvador Barreda Puchades &#8211; Hospital de Manises&#46; Marta Alonso &#193;lvarez &#8211; Hospital Vital &#193;lvarez-Buylla&#46; Jos&#233; Manuel Cancio &#8211; CSS El Carme&#44; Badalona Serveis Asistencials&#46; Pablo Alejandro Blanco Alba &#8211; Hospital San Juan de Dios de Bormujos&#46; Laura Puertas Molina &#8211; Hospital Universitari M&#250;tua de Terrassa&#46; Mar&#237;a Prado Cabillas &#8211; Hospital de La L&#237;nea de la Concepci&#243;n&#46; Eugenia Sonia Sopena Bert &#8211; Hospital Sociosanitari Francoli&#46; Berta Alvira Rasal &#8211; Hospital Universitario Infanta Elena de Valdemoro&#46; Manuel Lafuente &#8211; Hospital Mois&#233;s Broggi Consorci Sanitari Integral&#46; Ana Isabel Hormigo &#8211; Hospital Universitario Fundaci&#243;n Jim&#233;nez D&#237;az&#46; In&#233;s Gil Broce&#241;o &#8211; Complejo Hospitalario Universitario de Cartagena&#46; Marisa Garreta &#8211; Centre F&#243;rum&#44; Parc de Salut Mar&#44; Barcelona&#46; Enric Duaso &#8211; Consorcio Sanitario del Anoia&#44; Hospital de Igualada&#46; Nestor Pereira &#8211;Hospital de Lanzarote&#46; Gracia Meg&#237;as Baeza &#8211;Hospital Sagrado Coraz&#243;n de Sevilla&#46; Laura Alexandra Ivanov &#8211;Consorci Sanitari del GArraf&#46; Ver&#243;nica Garc&#237;a C&#225;rdenas &#8211;Hospital General de Villalba</p> <p id="par0380" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">National coordinators and coordinators for the Autonomous Communities</span></p> <p id="par0385" class="elsevierStylePara elsevierViewall">Pilar S&#225;ez L&#243;pez &#8211; Coordinador Nacional&#46; Juan Ignacio Gonz&#225;lez Montalvo &#8211; Director del Grupo 27 de IdiPAZ&#44; Centro Coordinador Nacional&#46; Anabel Llopis &#8211; Coordinador de Catalu&#241;a&#46; Pilar Mesa &#8211; Coordinador de Arag&#243;n&#46; Teresa Pareja &#8211; Coordinador de Castilla La Mancha&#46; Jes&#250;s Mora Fern&#225;ndez &#8211; Coordinador de la Comunidad de Madrid&#46; Ang&#233;lica Mu&#241;oz &#8211; Coordinador de Castilla y Le&#243;n&#46; Francisco Tarazona &#8211; Coordinador de la Comunidad Valenciana&#46; Marta Alonso &#8211; Coordinador de la Comunidad del Principado de Asturias&#46; Raquel Ort&#233;s &#8211; Coordinador de la Comunidad de Extremadura&#46; Marta P&#233;rez Garc&#237;a &#8211; Coordinador de Galicia&#46; I&#241;igo Etxebarria Foronda- Coordinador del Pa&#237;s Vasco</p> <p id="par0390" class="elsevierStylePara elsevierViewall">&#42;Listado de nombres al final del art&#237;culo</p>"
            "etiqueta" => "Annex I"
            "titulo" => "List of representatives&#44; delegates and participating hospitals during the first year of the National Hip Fracture registry"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">A&#46; HOSPITAL PHASE</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Informed Consent &#40;IC&#41; yes &#47; no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Registry number&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Age at the time of admission due to the fracture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Autonomous Community &#47; Postal Code&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hospital code&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prefracture place of residence&#58; home&#44; institutionalised&#44; acute hospitalization&#44; unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Prefracture mobility&#58; Modified FAC scale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Preoperative Mental Evaluation&#46; Validated spanish versi&#243;n of the Pfeiffer Questionnaire&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ASA surgical risk grade &#40;American Society of Anestesiologists&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Side affected by the fracture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pathological fractures&#58; malignancy &#47; atypical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Type of fracture&#58; non-displaced intracapsular&#44; displaced intracapsular&#44; intertrochanteric&#44; subtrochanteric&#44; other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bone protection drugs prior to the fracture&#58; antiresorptives yes&#47;no&#44; osteoforming yes&#47;no&#44; calcium yes&#47;no&#44; vitamin D yes&#47;no&#44; other antiostoporotic medication yes&#47;no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Date and time of admission to the emergency department&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vital status at discharge&#58; Alive&#44; deceased pre-surgery&#44; deceeased post-surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Type of surgery&#58; nonsurgical&#44; cannulated screws&#44; slising hip screw&#44; cephalomedullary nail&#44; hemiarthroplasty&#44; total hip replacement&#44; other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Date and time of surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Time from admission to surgery &#40;hours&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Type of Anesthesia&#58; General&#44; Spinal&#44; Anaesthetic Block yes&#47;no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pressure Ulcers grade II OR MORE developed during stay in hospital yes&#47;no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Presence of a clinical physician &#40;in the first 72<span class="elsevierStyleHsp" style=""></span>hours since admission&#41;&#58; Geriatrics&#44; Internal Medicine&#44; Other Specialist&#44; Not seen&#44; Unknown&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mobilization of the first day&#58; if the patient is mobilized from be don the day of surgery of the nect day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Destination upon discharge&#58; Home&#44; Nursing Home&#44; Acute Hospitalization&#44; Rehabilitation Unit&#44; Long Term Care Facility&#44; Deceased&#44; Unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Date of Discharge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Length of Stay &#40;hours&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bone-protection drugs upon discharge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">B&#46; POST-HOSPITALIZATION PHASE<br>The following variables are recorded 30 days after admission to Traumatology du to hip fracture&#46; It can be done bu a follow-up visit or a telephone interview&#46; An interval 3 days before or after the 30 days is accepted for data retrieval</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Readmission related to the hip fracture&#58; readmission due to orthopaedic surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Repeat surgery in the 30 days following admission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alive at 30 days&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 day mobility &#8211; use the same classification as point 2&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Plave of residence at 30 days&#58; Home&#44; Nursing Home&#44; Acute Hospitalization&#44; Rehabilitation Unit&#44; Long Term Care Facility&#44; Deceased&#44; Unknown&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bone protection drugs&#58; if the patient is taking bone protecting medication 30 days following the fracture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">List of variables of the National Hip Fracture Registry &#40;NHFR&#41; &#40;adaptation with a reverse translation reviewed&#44; from the dataset of the Fragility Fracture Network &#40;FFN&#41;&#41;&#46;</p>"
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      "titulo" => "References"
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          "identificador" => "bibs0015"
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            0 => array:3 [
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:6 [
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            1 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "2"
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                  "host" => array:1 [
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            2 => array:3 [
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            3 => array:3 [
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            4 => array:3 [
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                          "etal" => true
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                  "host" => array:1 [
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                      "doi" => "10.1007/s00198-013-2586-0"
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                          "estado" => "S300"
                          "issn" => "07351097"
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            5 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "6"
              "referencia" => array:1 [
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The orthogeriatric unit for acute patients&#58; a new model of care that improves efficiency in the management of patients with hip fracture"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;I&#46; Gonz&#225;lez-Montalvo"
                            1 => "T&#46; Alarc&#243;n"
                            2 => "J&#46;L&#46; Maule&#243;n"
                            3 => "E&#46; Gil-Garay"
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                            5 => "A&#46; Mart&#237;n-Vega"
                          ]
                        ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Hip Int"
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                        "volumen" => "20"
                        "paginaInicial" => "229"
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Spanish National Hip Fracture Registry (SNHFR): a description of its objectives, methodology and implementation

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