A quarter of older people who break a hip in the UK die within a year, and survivors face a drop in quality of life comparable to having a stroke—yet in low- and middle-income countries, where resources are scarcer, the outlook is even worse. Multidisciplinary care—where nurses, therapists, surgeons and medical specialists share responsibility for a patient—has improved outcomes for hip fracture patients in wealthier nations, but it has never been tested in low- and middle-income countries. This project will refine a training package called HIPCARE for hospitals in Sri Lanka, India, the Philippines, Thailand and Vietnam, then run a cluster randomised trial to see whether it improves patients’ health-related quality of life and reduces healthcare costs. If the HIPCARE package works, it could offer a low-cost, scalable way to cut deaths and disability from hip fractures across Asia, easing pressure on emergency and long-term care systems in countries where such support is most needed. The trial will also generate evidence that policymakers and global health networks can use to redesign fracture care in other resource-limited settings.
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Research Question: Does the multidisciplinary HIPCARE training and support package improve quality of life and reduce healthcare costs for patients with hip fracture? 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 LMIC. 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. Timeline The project will commence June 2022 and complete over a 4-year period. A Gannt chart outlining milestones and completion dates has been included. Impact/Dissemination: The impact plan for the HIPCARE trial uses Beckhard s model: Change = (Dissatisfaction + Vision + First steps) > Resistance, where the Change we are seeking is improved quality of life for people suffering hip fracture in LMIC in South Asia. We will use three modes of dissemination: 1. CEI: through plain language summaries specific to each country via social media and web-pages as well as hard-copy 2. Policymakers: through our partnership with the Global Fragility Fracture Network, with its many events worldwide 3. Healthcare professionals: through scientific publications and presentations
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