The development of a comprehensive multidisciplinary care pathway for patients with a hip fracture: design and results of a clinical trial.

Elvira R Flikweert,Gerbrand J Izaks,Martin Stevens,Klaus Wendt,Bas AS Knobben

doi:10.1186/1471-2474-15-188

Abstract

BackgroundHip fractures frequently occur in older persons and severely decrease life expectancy and independence. Several care pathways have been developed to lower the risk of negative outcomes but most pathways are limited to only one aspect of care. The aim of this study was therefore to develop a comprehensive care pathway for older persons with a hip fracture and to conduct a preliminary analysis of its effect.MethodsA comprehensive multidisciplinary care pathway for patients aged 60 years or older with a hip fracture was developed by a multidisciplinary team. The new care pathway was evaluated in a clinical trial with historical controls. The data of the intervention group were collected prospectively. The intervention group included all patients with a hip fracture who were admitted to University Medical Center Groningen between 1 July 2009 and 1 July 2011. The data of the control group were collected retrospectively. The control group comprised all patients with a hip fracture who were admitted between 1 January 2006 and 1 January 2008. The groups were compared with the independent sample t-test, the Mann–Whitney U-test or the Chi-squared test (Phi test). The effect of the intervention on fasting time and length of stay was adjusted by linear regression analysis for differences between the intervention and control group.ResultsThe intervention group included 256 persons (women, 68%; mean age (SD), 78 (9) years) and the control group 145 persons (women, 72%; mean age (SD), 80 (10) years). Median preoperative fasting time and median length of hospital stay were significantly lower in the intervention group: 9 vs. 17 hours (p < 0.001), and 7 vs. 11 days (p < 0.001), respectively. A similar result was found after adjustment for age, gender, living condition and American Society of Anesthesiologists (ASA) classification. In-hospital mortality was also lower in the intervention group: 2% vs. 6% (p < 0.05). There were no statistically significant differences in other outcome measures.ConclusionsThe new comprehensive care pathway was associated with a significant decrease in preoperative fasting time and length of hospital stay.

Highlights

Hip fractures frequently occur in older persons and severely decrease life expectancy and independence
The aim of this study was to investigate the first results of this new comprehensive care pathway for hip fractures, two years after implementation
The effect of the intervention on fasting time and length of stay was adjusted by linear regression analysis for differences between the intervention and control group at baseline

Summary

Introduction

Hip fractures frequently occur in older persons and severely decrease life expectancy and independence. The aim of this study was to develop a comprehensive care pathway for older persons with a hip fracture and to conduct a preliminary analysis of its effect. A hip fracture has a strong negative effect on activities of daily living and on quality of life. One year after the fracture, about 50% of patients are still more disabled than before the fracture, and during the first months after the operation the all-cause mortality rate rises up to eight-fold [1,2]. Optimizing medical care is important, as treatment for a hip fracture is associated with significant mortality and morbidity. The increase in mortality rate persists beyond 10 years after the fracture, and only 25% of patients regain their prefracture ability to perform instrumental activities of daily living [5]

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