Joint position on quality indicators for fragility hip fracture in Mexico.

Abstract

A standardized framework for quality indicators (QIs) in fragility hip fracture care is lacking in Mexico, leading to variable treatment. This study proposes 33 QIs developed through literature review and expert consensus. These indicators aim to improve multidisciplinary care, reduce complications, and optimize resources, supporting national efforts for standardized management. Fragility hip fractures present a major public health challenge due to high mortality, complications, and healthcare costs. In Mexico, the absence of a standardized framework for quality indicators (QIs) for the management of fragility hip fractures has led to significant variability in care. This article aims to propose a comprehensive set of QIs tailored to the Mexican healthcare system. The proposal was developed through a three-phase process: a systematic review of international literature, a RAND/UCLA-type consensus approach involving experts from nine national medical societies, and the evaluation of QIs based on the opportunity and necessity criteria. The final consensus led to the identification of 33 QIs, covering preoperative, intraoperative, postoperative, and perioperative phases of care. Key indicators include timely surgery (within 48 h), early mobilization, orthogeriatric co-management, nutritional assessment, fall prevention, delirium detection, and secondary fracture prevention upon discharge. These indicators are designed to promote multidisciplinary care, improve functional outcomes, and reduce complications. The process also included operational definitions and measurement criteria to facilitate implementation in clinical settings, potentially contributing to the creation of national or regional hip fracture registries. This proposal represents the first multidisciplinary initiative in Mexico to address fragility hip fracture care with the goal of standardizing quality, optimizing resource use, and improving patient outcomes. Ongoing evaluation and adaptation of these indicators will be crucial to ensure their continued relevance and effectiveness in the evolving healthcare landscape.