NHS Outcomes Framework 2014/15:

Transcription

1 NHS Outcomes Framework 2014/15: Domain 3 Helping people to recover from episodes of ill health or following injury Indicator specifications Version: 1.2 Date: August 2014 Author: Clinical Indicators Team 1 Copyright 2014, Health and Social Care Information Centre.

2 NHS Outcomes Framework 2014/15: Domain 3 Helping people to recover from episodes of ill health or following injury Contents 3a Emergency admissions for acute conditions that should not usually require hospital admission 3 3b Emergency readmissions within 30 days of discharge from hospital Total health gain as assessed by patients for elective procedures i) hip replacement ii) knee replacement iii) groin hernia iv) varicose vein Emergency admissions for children with lower respiratory tract infections (LRTIs) i Proportion of patients recovering to their previous levels of mobility/walking ability at 30 days ii Proportion of patients recovering to their previous levels of mobility/walking ability at 120 days i Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation service ii Proportion offered rehabilitation following discharge from acute or community hospital 44 Domain 3 Appendices 48 2

3 NHS Outcomes Framework 2014/15: 3a Emergency admissions for acute conditions that should not usually require hospital admission 3a Emergency admissions for acute conditions that should not usually require hospital admission Revision history Version Date Summary of Changes 1.0 November 2011 First release 1.1 March 2012 Breakdown details added 2.0 June 2012 Indicator now indirectly standardised 2.1 September 2012 Further disaggregations published 2.2 December 2012 Indicator standardised to 2011/12 using 2011 mid-year population estimates 3.0 March 2013 Indicator now includes children 3.1 September 2013 Additional data point for deprivation breakdown added 3.2 December 2013 Release with 2012/13 data 3.3 February May August 2014 Release of data for all years with revised ONS population estimates based on the 2011 Census Further disaggregations published (upper tier local authority, region and annual figures) Update of specification to refine HES filters and include an additional ADMIMETH filter Indicator assurance Status Methodology Review Group assured Date September 2011 Overview Indicator title 3a Emergency admissions for acute conditions that should not usually require hospital admission Indicator family name NHS Outcomes Framework: Domain 3 Helping people to recover from episodes of ill health or following injury Overarching indicator 3

4 NHS Outcomes Framework 2014/15: 3a Emergency admissions for acute conditions that should not usually require hospital admission Health and Social Care Information Centre Indicator Portal code I00711 Outcome sought Preventing conditions from becoming more serious. Detailed Descriptor Plain English description Indicator 3a measures the number of emergency admissions to hospital in England for acute conditions such as ear/nose/throat infections, kidney/urinary tract infections and heart failure, among others, that could potentially have been avoided if the patient had been better managed in primary care. Primary care describes community based health services that are usually the first, and often the only, point of contact that patients have with the health service. It covers services provided by family doctors (GPs), community and practice nurses, community therapists (such as physiotherapists and occupational therapists), community pharmacists, optometrists, dentists and midwives. Technical description Emergency admissions to hospital (indirectly standardised rate per 100,000 population) of persons with acute conditions (ear/nose/throat infections, kidney/urinary tract infections, heart failure, among others) that usually could have been avoided through better management in primary care. For a full list of the conditions included in this indicator please see appendix 1. Data sources Denominator: Mid-year population estimates for England published by the Office for National Statistics (ONS). England population estimates are released in the autumn following year end. Population estimates for breakdowns such as Lower Super Output Area (LSOA) are released later. Numerator: Hospital Episode Statistics (HES) Admitted Patient Care (APC), provided by the Health and Social Care Information Centre (HSCIC). Final annual and quarterly HES data are released in the November following the financial year-end. 4

5 NHS Outcomes Framework 2014/15: 3a Emergency admissions for acute conditions that should not usually require hospital admission Construction Calculation methodology Introduction This indicator measures the rate of emergency hospitalisation per 100,000 population for patients with acute conditions (ear/nose/throat infections, kidney/urinary tract infections, heart failure, among others that usually could have been avoided through better management in primary care. The data include emergency admissions for patients of all ages. Data Filters See appendix 1 for acute conditions that should not usually require hospital admission. The data fields and filters that are used are as follows. Details of HES fields and classifications are available in the HES Data Dictionary (see 1. Field Name: DIAG_3_01, DIAG_4_01, Description: Conditions: Primary diagnosis code consisting of 4 characters Any of (a) to (i) are true. Defined as follows: a) (DIAG_3_01 is equal to any of: A36, A37, B05, B06, B26, J10, J11, 14, OR DIAG_4_01 is equal to any of: J13X, J15.3, J15.4, J15.7, J15.9, J16.8, J18.1, J18.8, B16.1, B16.9, M01.4) AND DIAG_3_CONCAT does not contain: D57 [where DIAG_3_CONCAT is a concatenated field containing the values of all 20 diagnosis fields separated by commas. This condition excludes episodes with a subsequent diagnosis of D57 (Sickle-cell disorders)]. b) DIAG_4_01 is equal to any of: I24.0, I24.8, I24.9 AND OPERTN_3_CONCAT does not contain any of: A, B, C, D, E, F, G, H, I, J, K, L, M, N, O, P, Q, R, S, T, V, W, X0, X1, X2, X4, X5. c) DIAG_3_01 is equal to any of: E86, K52, A08, A09 OR DIAG_4_01 is equal to any of: A02.0, A04, A05.9, A07.2. d) DIAG_3_01 is equal to any of: N10, N11, N12 OR DIAG_4_01 is equal to any of:, N13.6, N15.9, N39.0, N30.0, 5

6 NHS Outcomes Framework 2014/15: 3a Emergency admissions for acute conditions that should not usually require hospital admission N30.8, N30.9. e) DIAG_4_01 is equal to any of: K25.0, K25.1, K25.2, K25.4, K25.5, K25.6, K26.0, K26.1, K26.2, K26.4, K26.5, K26.6, K27.0, K27.1, K27.2, K27.4, K27.5, K27.6, K28.0, K28.1, K28.2, K28.4, K28.5, K28.6 OR DIAG_3_01 is equal to either of: K20, K21 f) (DIAG_3_01 is equal to any of: L01, L02, L03, L04, L88 OR DIAG_4_01 is equal to any of: L08.0, L08.8, L08.9, L98.0, I89.1) AND (OPERTN_3_CONCAT does not contain any of: A, B, C, D, E, F, G, H, I, J, K, L, M, N, O, P, Q, R, S1, S2, S3, S41, S42, S43, S44, S45, S48, S49, T, V, W, X0, X1, X2, X4, X5 OR OPERTN_3_CONCAT is equal to: S47) g) DIAG_3_01 is equal to any of: H66, H67, J02, J03, J06 OR DIAG_4_01 is equal to either of: J31.2, J04.0. h) DIAG_3_01 is equal to any of: K13, K12, K02, K03, K04, K05, K06, K08 OR DIAG_4_01 is equal to: A69.0, K09.8, K09.9 Rationale: i) DIAG_3_01 is equal to either of: R56, O15 OR DIAG_4_01 is equal to: G25.3. This gives the primary diagnosis of the patient. 2. Field Name: STARTAGE Description: Age at start of episode Conditions: Is between (inclusive): 0 and 120 OR is between 7001 and 7007 (for babies) Rationale: This field describes the age of the patient at the start of their episode of care. For this indicator all ages are considered. 6

7 NHS Outcomes Framework 2014/15: 3a Emergency admissions for acute conditions that should not usually require hospital admission 3. Field Name: ADMIMETH Description: Conditions: Rationale: Method of admission Is equal to any of: 21, 22, 23, 24, 25, 28, 2A, 2B, 2C or 2D (25, 2A, 2B, 2C and 2D are valid from April 2013 and replace 28) This restricts the data to emergency admissions only. 4. Field Name: EPISTAT Description: Episode status Conditions: Is equal to one of: 1 or 3 Rationale: This includes both finished and unfinished hospital episodes. 5. Field Name: ADMIDATE Description: Conditions: Rationale: Date of admission Limited to admissions within the current financial year split by quarter. Quarter 1: 1 st April to 30 th June; Quarter 2: 1 st July to 30 th September; Quarter 3: 1 st October to 31 st December; Quarter 4: 1 st January to 31 st March. Data are presented quarterly with an admission date within the quarter of interest. 6. Field Name: SEX Description: Sex of patient Conditions: Is equal to either of: 1 or 2 Rationale: Data are shown for males and females separately. Data for persons are the sum of males and females and excludes the small number of records where sex was unknown or unspecified. 7. Field Name: EPIORDER Description: Episode order Conditions: Is equal to: 1 Rationale: This restricts the data to the first episode in a hospital spell. 8. Field Name: ADMISORC Description: Source of admission Conditions: Is not equal to any of: 51, 52, 53 Rationale: This excludes transfers. 7

8 NHS Outcomes Framework 2014/15: 3a Emergency admissions for acute conditions that should not usually require hospital admission 9. Field Name: EPITYPE Description: Episode type Conditions: Is equal to: 1 Rationale: This restricts the data to general episodes (excludes birth, delivery and mental health episodes). 10. Field Name: CLASSPAT Description: Patient classification Conditions: Is equal to: 1 Rationale: This restricts the data to ordinary admissions (excludes day case, regular day/night attenders and mothers/babies using only delivery facilities). 11. Field Name: RESLADST (2003/04 to 2010/11) Description: Conditions: Rationale: RESLADST_ONS (2011/12 onwards) Local authority district Is equal to a valid English Local Authority or equal to U This restricts the data to patients resident in England. U represents England unspecified. Calculation Denominator ONS mid-year population estimates (based on the 2011 Census). Numerator The number of finished and unfinished admission episodes, excluding transfers, for patients with an emergency method of admission and with a primary diagnosis of an acute condition that should not usually require hospital admission as shown in appendix 1. Standardisation The rate is indirectly standardised by age and gender to the reference year (2012/13). The age groups used are 0-4, 5-9, 10-14, 15-18, 19-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, and 90+. A standardised admission ratio (SAR) is calculated and converted into a rate by multiplying it by the overall event rate of patients in England in the reference year. The SAR is calculated as: Oi Oi O i i SAR E E n 8 i i i i i

9 NHS Outcomes Framework 2014/15: 3a Emergency admissions for acute conditions that should not usually require hospital admission where: Oi is the observed number of events in the subject population in age- and gender group i (i.e. the number of admissions for that group in a given year or quarter) Ei is the expected number of events in the subject population in age- and gender group i, that is, the expected number of events in that age- and gender group if the population in that year/quarter had the same distribution as the reference population (2012). It is calculated by multiplying the number of individuals in that group (ni) by the crude age-and gender-specific rate in the reference population ( i). This figure is then multiplied by 100 (for presentational purposes): ni is the number of individuals in the subject population in age- and gender group i (i.e. the number of individuals in that group in a given year or quarter) i is the crude age- and gender specific rate in the standard population in age-and gender group i (i.e. the crude age- and gender specific rate for that age- and gender group in 2012, which is the reference year) The indirectly standardised rate is the crude rate for the reference year multiplied by the SAR. When the indicator is broken down by gender, the value is indirectly standardised by age only. Similarly, when the indicator is broken down by age, the value is indirectly standardised by gender only. Confidence Intervals When calculating 95% confidence intervals for indirectly standardised ratios, it is assumed that the standard rates come from a population sufficiently large as to assume their sampling variance is negligible, and that the observed number of events O follows a Poisson distribution. Where the number of observed events is less than 500, the exact upper and lower limits for O are found from a look-up table and used to calculate the respective limits of the ratio. Where the number of observed events is 500 or more, confidence intervals are calculated using the method described by Goldblatt and Jones 1. The lower and upper confidence limits for the SAR are denoted by SAR_LL and SAR_UL. For O < 500: where: OLL SMR_LL 100 E OUL SMR_UL 100 E OLL/UL are the exact lower and upper 95% confidence limits from a standard Poisson distribution table for the total number of observed events O in the subject population. E is the total expected number of events in the subject population. 1 Goldblatt P and Jones D. Methods. In Longitudinal Study: Mortality and Social Organisation, ed P Goldblatt. London: Her Majesty s Stationery Office,

10 NHS Outcomes Framework 2014/15: 3a Emergency admissions for acute conditions that should not usually require hospital admission For O between 500 and 899: O SAR _LL E O O SAR _UL E O For O >= 900: O SAR _LL E O O SAR _UL E O The indirectly standardised rate upper and lower confidence intervals are calculated by multiplying the SAR upper and lower limits by the crude rate for the reference year. Presentation Breakdowns Time periods Quarterly and annual data from 2003/04 Q1 for all breakdowns Demographic Gender - male and female Age person Geographic Lower tier local authority person Upper tier local authority person Region - person Other Condition person 10

11 NHS Outcomes Framework 2014/15: 3a Emergency admissions for acute conditions that should not usually require hospital admission Disclosure control This indicator is calculated using HES data, following the HES Analysis Guide on suppression of small numbers. Where the indicator is calculated from a numerator of between one and five (inclusive), the value is suppressed and replaced with *. This is in order to protect against the potential for disclosing the identity of an individual. Secondary suppression is carried out where only one rate is suppressed for a certain breakdown and time period and this value could be calculated by differencing. This is to reduce the risk of one suppressed number being identifiable in isolation. As ONS population data were used for the denominator the values were rounded to the nearest 100. The rounding was carried out after the indicator value was calculated. Excel and CSV output Column name Year Quarter Period of coverage Breakdown Level Level description Indicator value Lower CI Upper CI Standardised ratio Standardised ratio lower CI Standardised ratio upper CI Observed Population Expected Percent unclassified Output Financial year Annual, quarter Actual time period the data cover England, gender, age band, lower and upper tier local authority, region, condition Detailed breakdown of each split - breakdown code Further description of level/breakdown Indirectly standardised rate (ISR) per 100,000 population ISR lower 95% confidence interval ISR upper 95% confidence interval Standardised admission ratio Standardised admission ratio lower confidence interval Standardised admission ratio upper confidence interval Number of observed events (numerator) Population count (denominator) Number of expected events The percentage of records where there is no LSOA recorded displayed for breakdowns lower and upper tier local authority and region 11

12 NHS Outcomes Framework 2014/15: 3b Emergency readmissions within 30 days of discharge from hospital 3b Emergency readmissions within 30 days of discharge from hospital Revision history Version Date Summary of Changes 1.0 June 2012 First release 1.1 December 2013 Release with 2011/12 data Indicator assurance Status Methodology Review Group assured Date May 2012 Overview Indicator title 3b Emergency readmissions within 30 days of discharge from hospital Indicator family name NHS Outcomes Framework: Domain 3 Helping people recover from episodes of ill health or following injury Overarching indicator Health and Social Care Information Centre Indicator Portal code I00712 Outcome sought Effective recovery form illnesses and injuries requiring hospitalisation. Detailed Descriptor Plain English description This indicator measures the percentage of emergency admissions of people who returned to hospital as an emergency within 30 days of the last time they left hospital after a stay. Admissions for cancer and obstetrics are excluded as they may be part of the patient s care plan. 12

13 NHS Outcomes Framework 2014/15: 3b Emergency readmissions within 30 days of discharge from hospital Technical description Indirectly standardised percentage of emergency admissions to any hospital in England occurring within 30 days of the last, previous discharge after admission. Admissions for cancer and obstetrics are excluded. Alignment with other Outcomes Frameworks Shared with Public Health Outcomes Framework Indicator 4.11 Data sources Denominator: Hospital Episode Statistics (HES) for continuous inpatient (CIP) spells intersecting the respective financial year, England, the Health and Social Care Information Centre. Numerator: Hospital Episode Statistics (HES) for CIP spells intersecting the respective financial year, plus those up to 30 days in the next financial year, England, the Health and Social Care Information Centre. The CIP spells are constructed using the method from the Compendium of population health indicators. Details can be found on the HSCIC Indicator Portal: see CIP spell construction sections in Annex 4 (Compendium of population health indicators > Additional reading > Statistical methods > Methods). Construction Calculation methodology Introduction This indicator measures the percentage of emergency admissions to any hospital in England occurring within 30 days of the most recent discharge from hospital. Readmissions for cancer and obstetrics are excluded. Data filters Denominator The following fields and values are used for the denominator. The first episode in the CIP spell has: 13 ADMIMETH = 11, 12, 13, 21, 22, 23, 24, 28, 31, 32, 81, 82, 83, 84 or 89 (admission method); AND EPITYPE = 1 (episode type); AND CLASSPAT = 1 (patient classification);

14 NHS Outcomes Framework 2014/15: 3b Emergency readmissions within 30 days of discharge from hospital AND AGE = 0-15 or , 16-74, 75+; AND DOB not 01/01/1900 or 01/01/1901 (date of birth); AND SEX = 1 or 2 (sex); AND EPIORDER = 1 (episode order); AND EPISTART is valid (episode start date); AND DIAG_01 does not begin with O (primary diagnosis). AND the last episode in the CIP spell has: DISDATE is valid and < 31/03/YYYY+1 (discharge date); AND EPITYPE = 1 (episode type); AND MAINSPEF not 501, 560, 610 (main specialty); AND DISMETH = 1, 2 or 3 (discharge method). Spells with any mention of a diagnosis of cancer (ICD-10 codes C00-C97, D37-D48) or chemotherapy for cancer (ICD-10 code Z51.1) are also excluded from the denominator, as are patients with mention of a diagnosis of cancer or chemotherapy for cancer anywhere in the 365 days prior to admission. Additionally, the following exclusions are applied (main specialty, first valid procedure and primary diagnosis): AND (episode where the first valid procedure took place MAINSPEF = 100, 101, 110, 120, 130, 140, 141, 142, 143, 150, 160, 170, 180 or 502 AND first valid procedure is not NULL) OR (first episode in CIP spell MAINSPEF = 100, 101, 110, 120, 130, 140, 141, 142, 143, 150, 160, 170, 180 or 502 OR (first episode in CIP spell MAINSPEF = 190, 191, 300, 301, 302, 303, 304, 305, 310, 311, 312, 313, 314, 315, 320, 330, 340, 350, 360, 361, 370, 371, 400, 401, 410, 420, 421, 430, 450, 460, 800, 810 or 823 and first episode in CIP spell DIAG_01 is not NULL)). There is an additional 3-step piece of logic, which is designed to ensure that the spells are allocated to the most appropriate group for standardisation: 14 Step A) Look for spells where there is a valid procedure and surgical specialty (taken from the episode where the procedure was found). Step B) Excluding spells selected in step A, select spells where main specialty in the first episode is surgical, these spells are standardised under the no procedures basket. Step C) Excluding those spells selected in step A and step B, select spells where main specialty of the first episode is medical.

15 NHS Outcomes Framework 2014/15: 3b Emergency readmissions within 30 days of discharge from hospital Those spells selected in A) are standardised by procedure subgroup. Note that procedures beginning with Y or Z are standardised in the no procedure basket. Those spells selected in C) are standardised by diagnosis subgroup. Lists of specialties and sub-groups used for filtering/standardisation: Specialties: Medical Specialties: '190', '191', '300', '301', '302', '303', '304', 305, '310', '311', '312', '313', '314', '315', '320', '330', '340', '350', '360', '361', '370', '371', '400', '401', '410', '420', '421', '430', '450', '460', '800', '810', '823. Surgical Specialties: '100', '101', '110', '120', '130', '140', '141', '142', '143', '150', '160', '170', '180', '502' Fields used from the first episode in a spell where there is a valid organisation of residence code include: SPELLRESPCTC, SPELLRESLADSTC., SPELLRESSTHAC. Other organisational levels (E, REGION, ONS Areas, Counties) are aggregates of the SPELLRESLADSTC field. Fields used from the last episode in a spell include: PROCODETC (provider code, unmapped). Provider clusters are aggregates of the PROCODETC field. Counts are by: age / sex / method of admission of discharge spell / diagnosis (ICD 10 chapter / selected sub-chapters within medical specialties) and procedure (OPCS 4 chapter / selected sub-chapters within surgical specialties) / organisation of residence in CIP spell (values for England are aggregates of these) where: age bands for the respective age specific indicators are: <1, 1-4, 5-9, 10-15,16-64, 65-74, 75-84, 85+ sex is 1, 2 (male and female); admission method is elective or non-elective; diagnosis (within medical specialties). 15

16 NHS Outcomes Framework 2014/15: 3b Emergency readmissions within 30 days of discharge from hospital Comments on denominator data There is variation in the completeness of hospital records and quality of coding (see Data Quality sections in Annex 4 (Additional reading > Statistical methods > Methods section of the HSCIC Indicator Portal: for details). Quality of coding shows the proportion of diagnoses not coded. There may also be variation between hospitals in the way diagnoses are coded to the twenty diagnosis fields in each episode, particularly primary diagnosis. For instance, they may code in the order in which the diagnoses were made, or according to their perceived importance or complexity. This may affect the group/subgroup within which a particular spell is selected for standardisation in this indicator. Similarly, there may be variation in which procedure is coded to the first position. The denominator consists of CIP spells that cover all continuous, consultant episodes for the same patient, including those following a transfer to another hospital. Denominator CIP spells must start with an admission episode and finish with a (live) discharge episode in the year of analysis. CIP spells with a discharge code of death are excluded from the denominator because readmission is not possible. Numerator The following fields and values are used for the numerator. The numerator is the number of denominator CIP spells where: Diagnosis of cancer is not coded in any position in the readmission spell; AND the first episode in readmission CIP spell ADMIDATE minus last episode in admission CIP spell DISDATE < 29 days inclusive (discharge date and admission date, includes negatives); AND the first episode in the readmission CIP spell has: ADMIMETH = 21, 22, 23, 24 or 28 (admission method); AND DIAG_01 does not begin with O (primary diagnosis) AND MAINSPEF not 501, 560, 610 (main specialty). Fields used from the first episode in a spell where there is a valid organisation of residence code include: SPELLRESPCTC, SPELLRESLADSTC, SPELLRESSTHAC. Other organisational levels (E, REGION, ONS Areas, Counties) are aggregates of the SPELLRESLADST field. Fields used from the last episode in a spell include: PROCODETC (provider code, unmapped). Provider clusters are aggregates of the PROCODETC field. 16

17 NHS Outcomes Framework 2014/15: 3b Emergency readmissions within 30 days of discharge from hospital Counts are by: age / sex / method of admission of discharge spell / diagnosis (ICD 10 chapter / selected sub-chapters within medical specialties) and procedure (OPCS 4 chapter / selected sub-chapters within surgical specialties) / organisation of residence in CIP spell (values for England are aggregates of these) where: age bands are :<1, 1-4, 5-9, 10-15, 16-64, 65-74, 75-84, 85+; sex is 1, 2 (male and female); admission method is elective or non-elective; diagnosis (within medical specialties); procedure (within surgical specialties). Comments on numerator data Individual finished consultant episodes are linked to other episodes where all are part of one continuous spell of care for a patient. A spell may contain HES data from another year only when one of its episodes spans years. For example, a spell which finished during April may contain admission information from an episode which started during the previous March. The numerator (readmissions) consists of CIP spells (see denominator) that include both finished and unfinished (i.e. finished episodes from following years) episodes i.e. readmissions can be finished and unfinished CIP spells. Where there is more than one readmission within 30 days, each readmission is counted once, in relation to the previous discharge. Readmissions that end in death are included in the numerator. Patients within the maternity specialties as well as those with a diagnosis of cancer have been excluded because in these cases emergency readmission is often considered a necessary part of care. Spells are attributed to the organisation of residence, based on the numerator. The indicator includes discharges occurring after transfer to another Trust. Discharges are counted to the first valid organisation coded in the spell for residence based aggregates, and to the discharging trust for trust based aggregates. 17

18 NHS Outcomes Framework 2014/15: 3b Emergency readmissions within 30 days of discharge from hospital Calculation Denominator The number of finished CIP spells within selected medical and surgical specialties, with a discharge date up to March 31st within the year of analysis. Day cases, spells with a discharge coded as death, maternity spells (based on specialty, episode type, diagnosis), and those with mention of a diagnosis of cancer or chemotherapy for cancer anywhere in the spell are excluded. Patients with mention of a diagnosis of cancer or chemotherapy for cancer anywhere in the 365 days prior to admission are excluded. Numerator The number of finished and unfinished continuous inpatient (CIP) spells that are emergency admissions and occur within 0-29 days (inclusive) of the last, previous discharge from hospital (see denominator), including those where the patient dies, but excluding the following: those with a main specialty upon readmission coded under obstetric and those where the readmitting spell has a diagnosis of cancer (other than benign or in situ) or chemotherapy for cancer coded anywhere in the spell. The date of the last, previous discharge from hospital, and the date and method of admission from the following CIP spell, are used to determine the interval between discharge and emergency readmission. The numerator is based on a pair of spells, the discharge spell and the next subsequent readmission spell (this spell must meet the numerator criteria). The selection process thus carries over the characteristics of the denominator for the discharge spell and applies additional ones to the readmission spell. Standardisation The indicator is indirectly standardised by age, sex, method of admission and diagnosis / procedure. The person-based rate is standardised by using England age, sex, method of admission and diagnosis / procedure rates as standards. We defined the diagnosis and procedure groups for standardisation at ICD 10 / OPCS 4 coding chapter, sub-chapter or 3 digit level where the readmission rate was significantly different from that of the next higher level in two consecutive financial years and there were at least 50 discharges in each year. The gender specific rates are standardised using person based standards, in order to highlight differences across gender. Indirect standardisation involves the calculation of the ratio of an organisation s observed number of events and the number of events that would be expected if it had experienced the same event rates as those of patients in England, given the mix of age, sex, method of admission and diagnosis / procedure of its patients. This standardised ratio is then converted into a rate by multiplying it by the overall event rate of patients in England. The method used for indirect standardisation is the one used in the Compendium of population health indicators. Details are available in Annex 3 Explanation of statistical methods (Compendium of population health indicators > Additional reading > Statistical methods > Methods section of the HSCIC Indicator Portal 18

19 NHS Outcomes Framework 2014/15: 3b Emergency readmissions within 30 days of discharge from hospital Confidence Intervals The method used for the estimation of confidence intervals is the one used in the Compendium of population health indicators. Details are available in Annex 3 Explanation of statistical methods (Compendium of population health indicators > Additional reading > Statistical methods > Methods section of the HSCIC Indicator Portal Presentation Breakdowns Time periods Annual data from 2002/03 for England Demographic Gender (male and female) Persons by deprivation quintile Geographic Persons at England level, by local authority and region Disclosure control No suppression is currently carried out as the indicator values are shown as rates and therefore no risk of disclosure has been identified. Excel and CSV output Column name Year Breakdown Level Level description Indicator value Lower CI Upper CI Output Financial year England, gender, local authority, region, deprivation quintile Detailed breakdown of each split (see Breakdown) - breakdown code Detailed breakdown of each split (see Breakdown) - breakdown description Indirectly standardised percentage rate Lower limit of 95% confidence interval Upper limit of 95% confidence interval 19

20 NHS Outcomes Framework 2014/15: 3.1 Total health gain as assessed by patients for elective procedures i) hip replacement ii) knee replacement iii) groin hernia iv) varicose vein 3.1 Total health gain as assessed by patients for elective procedures i) hip replacement ii) knee replacement iii) groin hernia iv) varicose vein Revision history Version Date Summary of Changes 1.0 November 2011 First release 1.1 March 2012 Release with first disaggregations 1.2 September 2012 Release with latest years data 1.3 March 2013 Release including additional information (number of eligible episodes and total health gain for England only) 1.4 December 2013 Release with 2011/12 data 1.5 May 2014 Change in layout of data Indicator assurance Status Methodology Review Group assured Date July 2011 Overview Indicator title 3.1 Total health gain as assessed by patients for elective procedures i) hip replacement ii) knee replacement iii) groin hernia iv) varicose vein Indicator family name NHS Outcomes Framework Domain 3: Helping people to recover from episodes of ill health or following injury Improvement area Improving outcomes from planned treatments 20

21 NHS Outcomes Framework 2014/15: 3.1 Total health gain as assessed by patients for elective procedures i) hip replacement ii) knee replacement iii) groin hernia iv) varicose vein Health and Social Care Information Centre Indicator Portal code I00713 Outcome sought Increased health gain from planned procedures. Detailed Descriptor Plain English description This indicator measures improvements in health as a result of planned medical procedures for groin hernia, hip replacement, knee replacement and varicose veins. Technical description Total health gain from patients who reported an improvement in health status following elective procedures, currently covering groin hernia, hip replacement, knee replacement and varicose veins. The Patient Reported Outcome Measure (PROMs) indicator is reported separately for the four conditions. Data sources PROMs dataset (Source provider: HSCIC). Final annual confirmed PROMS data are released approximately 18 months after the end of the reporting year. Data for 2011/12 were released in October Construction Calculation methodology Introduction The EQ-5D TM index case-mix adjusted average health gain is reported separately for: groin hernia; hip replacement; knee replacement and varicose veins. Additionally the number of eligible episodes is provided for each of the four procedures at England and Provider level. This information is used to calculate the total health gain, which is published at national level only. Calculation The values for the national figure as well as all breakdowns of the EQ-5D TM index case-mix adjusted average health gain are sourced fully calculated. The total health gain at national level is calculated by multiplying the average health gain with the number of eligible episodes for each procedure. PROMs comprise a pair of questionnaires completed by the patient, one before and one after surgery (at least three months after for groin hernia and varicose vein operations, or at least six months after for hip and knee replacements). Patients' self-reported health status (sometimes referred to as health related quality of life) is assessed through a mixture of 21

22 NHS Outcomes Framework 2014/15: 3.1 Total health gain as assessed by patients for elective procedures i) hip replacement ii) knee replacement iii) groin hernia iv) varicose vein generic and disease or condition-specific questions. To add to the value of the PROMs questionnaire data, it is linked routinely with Hospital Episode Statistics (HES) episode-level information. The EQ-5D is a standardised instrument for use as a measure of health outcome. It is a registered trademark of EuroQol. Further details are available from The PROMs website provides a list of all of the items in the PROMs dataset in the PROMS Data Dictionary and a guide to the methodology used: The copyright to the information is held by the Health and Social Care Information Centre (HSCIC). The HSCIC has suspended the application of re-use licence fees as a consequence of government policy ('Making Public Data Public'), so you may re-use this information free of charge. Please ensure that the following copyright statement is included within your documents: 'Copyright 2014 Re-used with the permission of the Health and Social Care Information Centre. All rights reserved.' Full details of the terms and conditions can be found at Presentation Breakdowns Time periods Annual data from 2009/10 for England Demographic Persons, male and female by age band Persons, male and female by ethnicity Persons, male and female by disability Persons, male and female by deprivation decile Disclosure control Numerators (number of eligible episodes) and score are suppressed if the numerator is between one and five (inclusive). Average case-mix adjusted scores have been calculated only where there are at least 30 modelled records, as the statistical models break down with fewer records and aggregate calculations on small numbers may return unrepresentative results. 22

23 NHS Outcomes Framework 2014/15: 3.1 Total health gain as assessed by patients for elective procedures i) hip replacement ii) knee replacement iii) groin hernia iv) varicose vein Excel and CSV output Column name Year Period of coverage Breakdown Level Level description Gender Indicator value (reported separately for groin hernia; hip replacement; knee replacement and varicose veins) Output Financial year 01/04 to 31/03 of respective year England, gender, age, ethnicity, disability, deprivation decile, provider, PCT, SHA Detailed breakdown of each split (see Breakdown) - breakdown code Description of detailed breakdown (e.g. Age 10 to 14, 15 to 19 etc.) Person, male and female Number of eligible episodes (at national and provider-level only). EQ-5D TM index case-mix adjusted average health gain. Total health gain (at national level only) 23

24 NHS Outcomes Framework 2014/15: 3.2 Emergency admissions for children with lower respiratory tract infections (LTRIs) 3.2 Emergency admissions for children with lower respiratory tract infections (LRTIs) Revision history Version Date Summary of Changes 1.0 November 2011 First release 1.1 March 2012 Breakdown details added 2.0 June 2012 Indicator now indirectly standardised 2.1 September 2012 Further disaggregations published 2.2 December 2012 Indicator standardised to 2011/ September 2013 Additional data point for deprivation breakdown added 2.4 December 2013 Release of 2012/13 data 2.5 February 2014 Release of data for all years with revised ONS population estimates based on the 2011 Census 2.6 May 2014 Further disaggregation published (annual figures) 2.7 August 2014 Update of specification to refine HES filters and include an additional ADMIMETH filter Indicator assurance Status Methodology Review Group assured Date September 2011 Overview Indicator title 3.2 Emergency admissions for children with lower respiratory tract infections (LRTIs) Indicator family name NHS Outcomes Framework: Domain 3: Helping people to recover from episodes of ill health or following injury Improvement area Preventing lower respiratory tract infections (LRTIs) in children from becoming more serious 24

25 NHS Outcomes Framework 2014/15: 3.2 Emergency admissions for children with lower respiratory tract infections (LTRIs) Health and Social Care Information Centre Indicator Portal code I00714 Outcome sought Preventing lower respiratory tract infections in children from becoming more serious. Detailed Descriptor Plain English description This indicator measures the number of children (0 to 18 years) admitted to hospital in an emergency for some respiratory infections (bronchiolitis, bronchopneumonia and pneumonia). Technical description Emergency admissions to hospital of children with selected types of lower respiratory tract infections (bronchiolitis, bronchopneumonia and pneumonia). It is expressed as the indirectly standardised rate of admissions per 100,000 population aged under 19 (0 to 18 years). Data sources Denominator: Mid-year population estimates for England, published by the Office for National Statistics (ONS). Population estimates are released in the autumn following year end. Population estimates for breakdowns such as Lower Super Output Area (LSOA) and ethnicity are released later. Numerator: Hospital Episode Statistics (HES) Admitted Patient Care (APC), provided by the HSCIC. Final annual HES data are released in the November following the financial year-end. Construction Calculation methodology Introduction The number of finished and unfinished admission episodes, excluding transfers, for patients under 19 (0 to 18 years) with an emergency method of admission and with a primary diagnosis of a lower respiratory tract infection as shown below. The data are filtered to include emergency admissions for patients aged under 19 years only. A data period of 3 months is used to produce each of the quarterly outputs. The rate is indirectly standardised by age and gender to the most recently complete financial year s data. 25

26 NHS Outcomes Framework 2014/15: 3.2 Emergency admissions for children with lower respiratory tract infections (LTRIs) Data Filters See appendix 2 for conditions included in indicator 3.2. The data fields and filters that are used are as follows. Details of HES fields and classifications are available in the HES Data Dictionary: 1. Field Name: DIAG_3_01, DIAG_4_01 Conditions: Rationale: DIAG_3_01 is equal to any of: J13, J14 OR DIAG_4_01 is equal to any of: J10.0, J11.0, J11.1, J12.-, J15.-, J16.-, J18.0, J18.1, J18.9, J21.- These fields give the primary diagnosis of the patient in the episode of interest. 2. Field Name: STARTAGE Conditions: Is between (inclusive): 0 and 18 OR Is between (inclusive): 7001 and 7007 (for babies) Rationale: This field describes the age of the patient at the start of their episode of care. For this indicator only patients under the age of 19 are considered. 3. Field Name: ADMIMETH Conditions: Rationale: Is equal to any of the following: 21, 22, 23, 24,25, 28, 2A, 2B, 2C or 2D (25, 2A, 2B, 2C and 2D are valid from April 2013 and replace 28) This restricts the data to emergency admissions only. 4. Field Name: EPISTAT Conditions: Is equal to either of: 1 or 3 Rationale: This includes both finished and unfinished hospital episodes. 5. Field Name: ADMIDATE Conditions: Limited to admissions within the current financial year split by quarter. Quarter 1: 1 st April to 30 th June; 26

27 NHS Outcomes Framework 2014/15: 3.2 Emergency admissions for children with lower respiratory tract infections (LTRIs) Quarter 2: 1 st July to 30 th September; Quarter 3: 1 st October to 31 st December; Quarter 4: 1 st January to 31 st March. Rationale: Data are presented quarterly with an admission date within the quarter of interest. 6. Field Name: SEX Conditions: Is equal to either of: 1 or 2 Rationale: Data are shown for males and females separately. Data for persons are the sum of males and females and exclude the small number of records where sex was unknown or unspecified. 7. Field Name: EPIORDER Conditions: Is equal to: 1 Rationale: This restricts the data to the first episode in a hospital spell. 8. Field Name: ADMISORC Conditions: Is not equal to any of: 51, 52, 53 Rationale: This excludes transfers. 9. Field Name: EPITYPE Conditions: Is equal to: 1 Rationale: This restricts the data to general episodes (excludes birth, delivery and mental health episodes). 10. Field Name: CLASSPAT Conditions: Is equal to: 1 Rationale: This restricts the data to ordinary admissions (excludes day case, regular day/night attenders and mothers/babies only using delivery facilities). 10. Field Name: RESLADST (2003/04 to 2010/11) 27

28 NHS Outcomes Framework 2014/15: 3.2 Emergency admissions for children with lower respiratory tract infections (LTRIs) RESLADST_ONS (2011/12 onwards) Conditions: Rationale: Is equal to a valid English Local Authority or equal to U This restricts the data to patients resident in England. U represents England unspecified. Calculation The rate is indirectly standardised by age and gender to the reference year (2012/13). Numerator The number of finished and unfinished admission episodes, excluding transfers, for patients aged under 19 with an emergency method of admission and where lower respiratory tract infection was the primary diagnosis. Denominator Resident population aged 0-18 inclusive, based on ONS mid-year population estimates. Standardisation The rate is indirectly standardised by age and gender to the most recent financial year in the data. The age groups used are single years of age, A standardised admission ratio (SAR) is calculated and converted into a rate by multiplying it by the overall event rate of patients in England in the most recent financial year. The SAR is calculated as: Oi Oi O i i SAR E Ei ni i i i where: Oi is the observed number of events in the subject population in age- and gender group i (i.e. the number of admissions for that group in a given year or quarter) Ei is the expected number of events in the subject population in age- and gender group i, that is, the expected number of events in that age- and gender group if the population in that year/quarter had the same distribution as the reference population (2012). It is calculated by multiplying the number of individuals in that group (ni) by the crude age-and gender-specific rate in the reference population ( i). This figure is then multiplied by 100 (for presentational purposes): ni is the number of individuals in the subject population in age- and gender group i (i.e. the number of individuals in that group in a given year or quarter) i is the crude age- and gender specific rate in the standard population in age-and gender group i (i.e. the crude age- and gender specific rate for that age- and gender group in 2012, which is the reference year) 28

29 NHS Outcomes Framework 2014/15: 3.2 Emergency admissions for children with lower respiratory tract infections (LTRIs) The indirectly standardised rate is the crude rate for the reference year multiplied by the SAR. When the indicator is broken down by gender, the value will be indirectly standardised by age only. In addition, when the indicator is broken down by age, the value will be indirectly standardised by gender only. Confidence Intervals When calculating 95% confidence intervals for indirectly standardised ratios, it is assumed that the standard rates come from a population sufficiently large as to assume their sampling variance is negligible, and that the observed number of events O follows a Poisson distribution. Where the number of observed events is less than 500, the exact upper and lower limits for O are found from a look-up table and used to calculate the respective limits of the ratio. Where the number of observed events is 500 or more, confidence intervals are calculated using the method described by Goldblatt and Jones 2. The lower and upper confidence limits for the SAR are denoted by SAR_LL and SAR_UL. For O < 500: where: OLL SMR_LL 100 E OUL SMR_UL 100 E OLL/UL are the exact lower and upper 95% confidence limits from a standard Poisson distribution table for the total number of observed events O in the subject population. E is the total expected number of events in the subject population. For O between 500 and 899: O SAR _LL E O O SAR _UL E O For O >= 900: O SAR _LL E O O SAR _UL E O Goldblatt P and Jones D. Methods. In Longitudinal Study: Mortality and Social Organisation, ed P Goldblatt. London: Her Majesty s Stationery Office,

30 NHS Outcomes Framework 2014/15: 3.2 Emergency admissions for children with lower respiratory tract infections (LTRIs) The indirectly standardised rate upper and lower confidence intervals are calculated by multiplying the SAR upper and lower limits by the crude rate for the most recent year. Presentation Breakdowns Time periods Annual and quarterly data from 2003/04 Q1 for England Demographic Gender - male and female (annual and quarterly data) Age person by 1-year age band (annual and quarterly data) Geographic Lower tier local authority, upper tier local authority and region person (annual and quarterly data) Other Condition person (annual and quarterly data) A list of conditions for indicator 3.2 can be found in appendix 2. Disclosure control This indicator is calculated using HES data, following the HES Analysis Guide on suppression of small numbers. Where the indicator is calculated from a numerator of between 1 and 5 (inclusive) the value is suppressed and replaced with *. This is in order to protect against the potential for disclosing the identity of an individual. Secondary suppression is carried out where only one rate is suppressed for a certain breakdown and time period and this value could be calculated by differencing. This is to reduce the risk of one suppressed number being identifiable in isolation. As ONS population data were used for the denominator the values were rounded to the nearest 100. The rounding was carried out after the indicator value was calculated. 30

31 NHS Outcomes Framework 2014/15: 3.2 Emergency admissions for children with lower respiratory tract infections (LTRIs) Excel and CSV output Column name Year Quarter Period of coverage Breakdown Level Level description Indicator value Lower CI Upper CI Standardised ratio Standardised ratio lower CI Standardised ratio upper CI Observed Population Expected Percent unclassified Output Financial year Annual, quarter Actual time period the data cover England, gender, age band, lower tier local authority, condition Detailed breakdown of each split - breakdown code Further description of level/breakdown Indirectly standardised rate (ISR) per 100,000 population ISR lower 95% confidence interval ISR upper 95% confidence interval Standardised admission ratio Standardised admission ratio lower confidence interval Standardised admission ratio upper confidence interval Number of observed events (numerator) Population count (denominator) Number of expected events The percentage of records where there is no LSOA recorded displayed for breakdowns by local authority 31

32 NHS Outcomes Framework 2014/15: 3.5.i Proportion of patients recovering to their previous levels of mobility/walking ability at 30 days 3.5.i Proportion of patients recovering to their previous levels of mobility/walking ability at 30 days Revision history Version Date Summary of Changes 1.0 December 2012 First release 1.1 September 2013 Release with 2012 data Indicator assurance Status Methodology Review Group assured Date November 2012 Overview Indicator title 3.5.i Proportion of patients recovering to their previous levels of mobility/walking ability at 30 days Indicator family name NHS Outcomes Framework Domain 3: Helping people to recover from episodes of ill health or following injury Improvement area Improving recovery from fragility fractures Health and Social Care Information Centre Indicator Portal code I00717 Outcome sought Effective recovery of mobility following a fragility fracture. Detailed Descriptor Plain English description This indicator measures the proportion of patients with a fracture resulting from a fall from standing height or less that would not ordinarily cause a fracture in a normal adult (a fragility fracture) recovering to their previous levels of mobility at 30 days after admission to hospital. 32

33 NHS Outcomes Framework 2014/15: 3.5.i Proportion of patients recovering to their previous levels of mobility/walking ability at 30 days Technical description The proportion of patients with a fragility fracture recovering to their previous levels of mobility at 30 days after admission. Data sources Denominator and numerator: National Hip Fracture Database (NHFD). (Source provider: Health Quality Improvement Partnership). The NHFD National report is published approximately 6 months after the end of the reporting year. Construction Calculation methodology Introduction This indicator measures the proportion of patients recovering to a level of mobility at 30 days no more than 1 category lower than their mobility score prior to the fracture. There are five mobility categories within the NHFD. Patients within the NHFD have their mobility status categorised according to the algorithm outlined below. The indicator only includes patients with a pre fracture mobility score in either category 1, 2 or 3. This is because any patient in either category 4 or 5 cannot fall more than 1 mobility category and therefore will always be determined to have recovered. A more detailed explanation is provided in the Quality Statement published alongside the indicator data. Cat New Outcome Indicator Definition 1 Regularly mobile outdoor without aids (or assistance) 2 Mobile outdoors with only one aid 3 Mobile outdoors with 2 aids or a frame Definition as per NHFD data fields Walking ability outdoors = Regularly walked without aids -AND- Accompanied to walk outdoors = No Walking ability outdoors = Regularly walked with one aid -AND- Accompanied to walk outdoors = No Walking ability outdoors = Regularly walked with two aids or frame -AND- 33

34 NHS Outcomes Framework 2014/15: 3.5.i Proportion of patients recovering to their previous levels of mobility/walking ability at 30 days Accompanied to walk outdoors = No 4 Indoor mobility only, but never goes out unassisted Walking ability indoors -AND- 5 No functional mobility (wheelchair or assisted transfers or bedbound) Walking ability indoors = Wheelchair or bedbound -AND- Data filters For this indicator the source of the data is the NHFD. The extract from NHFD was restricted to: Patients 60 to 110 years old inclusive Patients with a pre fracture mobility score in category 1, 2 or 3 Patients admitted between January 1, and December 31, for the year to be reported (plus a period of 120 days follow-up for all patients in extract) Patients are eligible for the 30 days analysis if their mobility categories at admission and on the given day were available. Information about the NHFD can be found in the NHFD 2012 report available at: Calculation The proportion of patients recovering to a level of mobility at 30 days no more than 1 category lower than their mobility score prior to the fracture as described below: Denominator All patients in the data extract, as described above. 34

35 NHS Outcomes Framework 2014/15: 3.5.i Proportion of patients recovering to their previous levels of mobility/walking ability at 30 days Numerator Number of patients in the extract whose mobility category at 30 days was lower (i.e., better), the same or only one mobility category higher (i.e., worse) than mobility category at admission. Presentation Breakdowns Time periods Annual data from 2011 for England Demographic Persons by age, gender and mobility category Geographic National level data only Disclosure control As the indicator is only published broken down by gender, age and mobility category all numerator values (incidence of hip fracture) are above 100. Therefore disclosure control does not need to be applied. Excel and CSV output Column name Year Period of coverage Breakdown Level Output Calendar year 01/01 to 31/12 of the respective calendar year England, gender, age, mobility category at admission More detailed descriptor of breakdown Indicator value Proportion of admitted patients whose mobility category at 30 days was lower (i.e., better), the same or only one mobility category higher (i.e., worse) than the pre-fracture mobility category. Count of patients Number of admitted patients with a mobility score of 1, 2 or 3 recorded at admission, and a mobility score recorded at 30 days Count of patients who recovered Number of patients in the extract whose mobility category at 30 days was lower (i.e., better), the same or only one mobility category higher (i.e., worse) than mobility category at admission 35

36 NHS Outcomes Framework 2014/15: 3.5.ii Proportion of patients recovering to their previous levels of mobility/walking ability at 120 days 3.5.ii Proportion of patients recovering to their previous levels of mobility/walking ability at 120 days Revision history Version Date Summary of Changes 1.0 December 2012 First release 1.1 September 2013 Release with 2012 data Indicator assurance Status Methodology Review Group assured Date November 2012 Overview Indicator title 3.5.ii Proportion of patients recovering to their previous levels of mobility/walking ability at 120 days Indicator family name NHS Outcomes Framework Domain 3: Helping people to recover from episodes of ill health or following injury Improvement area Improving recovery from fragility fractures Health and Social Care Information Centre Indicator Portal code I00718 Outcome sought Effective recovery of mobility following a fragility fracture. Detailed Descriptor Plain English description This indicator measures the proportion of patients with a fracture resulting from a fall from standing height or less that would not ordinarily cause fracture in a normal adult (a fragility fracture) recovering to their previous levels of mobility at 120 days after admission to hospital. 36

37 NHS Outcomes Framework 2014/15: 3.5.ii Proportion of patients recovering to their previous levels of mobility/walking ability at 120 days Technical description The proportion of patients with a fragility fracture recovering to their previous levels of mobility at 120 days after admission. Data sources Denominator and numerator: National Hip Fracture Database (NHFD). (Source provider: Health Quality Improvement Partnership). The NHFD National report is published approximately 6 months after the end of the reporting year. Construction Calculation methodology Introduction This indicator measures the proportion of patients recovering to a level of mobility at 120 days no more than 1 category lower than their mobility score prior to the fracture. There are five mobility categories within the NHFD. Patients within the NHFD have their mobility status categorised according to the algorithm outlined below. The indicator only includes patients with a pre fracture mobility score in either category 1, 2 or 3. This is because any patient in either category 4 or 5 cannot fall more than 1 mobility category and therefore will always be determined to have recovered. A more detailed explanation is provided in the Indicator Quality Statement published alongside the indicator data. Cat New Outcome Indicator Definition 1 Regularly mobile outdoor without aids (or assistance) 2 Mobile outdoors with only one aid 3 Mobile outdoors with 2 aids or a frame Definition as per NHFD data fields Walking ability outdoors = Regularly walked without aids -AND- Accompanied to walk outdoors = No Walking ability outdoors = Regularly walked with one aid -AND- Accompanied to walk outdoors = No Walking ability outdoors = Regularly walked with two aids or frame -AND- 37

38 NHS Outcomes Framework 2014/15: 3.5.ii Proportion of patients recovering to their previous levels of mobility/walking ability at 120 days Accompanied to walk outdoors = No 4 Indoor mobility only, but never goes out unassisted Walking ability indoors -AND- 5 No functional mobility (wheelchair or assisted transfers or bedbound) Walking ability indoors = Wheelchair or bedbound -AND- Data filters For this indicator the source of the data is the NHFD. The extract from NHFD was restricted to: Patients 60 to 110 years old inclusive Patients with a pre fracture mobility score in category 1, 2 or 3 Patients admitted between January 1, and December 31, for the year to be reported (plus a period of 120 days follow-up for all patients in extract) Patients are eligible for the 120 days analysis if their mobility categories at admission and on the given day were available. Information about the NHFD can be found in the NHFD 2012 report available at: Calculation The proportion of patients recovering to a level of mobility at 120 days no more than 1 category lower than their mobility score prior to the fracture as described below: Denominator All patients in the data extract, as described above. 38