HIPCARE: a cluster randomised controlled trial with embedded process and economic evaluations

Background

Older people frequently sustain fractures after falls from a standing height, as their bones are weakened by osteoporosis. These ‘fragility’ fractures have serious consequences; 25% of hip fracture patients in the UK die within a year and survivors have a reduction in their quality-of-life similar to having a stroke. The outlook is even worse for people in low and middle-income countries (LMIC) with fewer resources to support recovery and long term care.

Many higher-income countries have introduced multidisciplinary care pathways for patients with hip fracture. Multidisciplinary care involves nurses, therapists, surgeons and medical specialists working together with joint responsibilities. Multidisciplinary care has not been tested in LMICs. This proposal is to refine and then test a multidisciplinary care training and support package for patients with hip fracture in LMIC in Asia, to address the RIGHT call 4 by reducing the global burden of unintentional injuries and urgent and emergency care.

Aims and objectives

Our aim is to improve health-related quality of life for patients following hip fracture and to reduce healthcare costs.

The project will have two parts:

1. To refine the multidisciplinary HIPCARE training package taking into account the specific healthcare context of five different LMIC in Asia.

2. To deliver a cluster randomised trial of the HIPCARE training package with embedded process and economic evaluations.

Methods

Setting: Hospitals in Sri Lanka, India, Philippines, Thailand and Vietnam; 6-8 public hospitals in each LMIC that treat 200+ patients with hip fractures annually.

Randomisation: Hospitals will be randomised to HIPCARE or usual care, via a centralised computer-based process stratified by country.

Inclusion criteria: Patients 60 years or over having surgery for a hip fracture.

Exclusion criteria: Patients not available for follow-up at 120 days.

INTERVENTION GROUP: Intervention sites will be provided with a multi-disciplinary intervention training package with online support, which will also outline the metrics of success.

CONTROL GROUP: Usual care. All hospitals randomised to the control group will be offered access to the HIPCARE training and support package at the conclusion of the trial.

Outcome measures: We will collect the Core Outcome Set for hip fracture trials at 120 days after surgery, the primary outcome measure being Health-related Quality of Life.