Comparison between care as usual and a comprehensive care pathway for the treatment of hip fractures.

Hip fractures constitute an economic burden on healthcare resources. Most
persons with a fracture have surgery. However, perioperative care leaves much room for
improvement. It can be improved if it is organized in comprehensive care pathways but these
pathways have never been studied in randomized controlled trials (RCT). The main reason for
this is that RCT´s are difficult to execute in this patient group. To overcome this dilemma a
prospective observational study will be conducted in which by means of the application of
Propensity Score Matching (PSM)* a RCT will be simulated. The objective of this study is to
determine the clinical effectiveness of a new comprehensive care pathway for the treatment of
hip fractures compared with care as usual. A prospective observational study will be
conducted in which the new comprehensive care pathway of UMCG Groningen will be
compared with care as usual at Martini Hospital Groningen and at Ommelander Ziekenhuis Groep.
The hypothesis is that 15% more patients at the UMCG compared with patients in the care as usual condition will recover at
least as well at 6 months follow-up as before the fracture in Activities of Daily Living.
Patients aged 60 and older will be included.

The hypothesis is that 15% more
patients in the comprehensive care pathway compared with patients in the care as usual condition will recover at
least as well at 6 months follow-up as before the fracture in Activities of Daily Living.

Measurements will be taken perioperatively, and at 6 weeks and 3 and 6 months after surgery.

In the new comprehensive care pathway at UMCG the treatment and the role of every participant is described from the arrival at the emergency room until discharge from the nursing home. Main features of this new treatment protocol are
multidisciplinary cooperation between trauma surgeon, orthopedic surgeon, geriatrician and anesthesiologist, a preoperative workup protocol, a clearly defined moment of surgery and a
postoperative protocol together with the physiotherapist and nursing home physician. The comprehensive care pathway doesn’t end with discharge from the hospital.