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Open Access Study protocol

Evaluation of the effect of a comprehensive multidisciplinary care pathway for hip fractures: design of a controlled study

Elvira R Flikweert1*, Gerbrand J Izaks2, Inge HF Reininga1, Klaus W Wendt1 and Martin Stevens3

Author Affiliations

1 Department of Surgery-Traumatology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands

2 University Center for Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

3 Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

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BMC Musculoskeletal Disorders 2013, 14:291  doi:10.1186/1471-2474-14-291

Published: 12 October 2013

Abstract

Background

Hip fractures constitute an economic burden on healthcare resources. Most persons with a hip fracture undergo surgery. As morbidity and mortality rates are high, perioperative care leaves room for improvement. Improvement can be achieved if it is organized in comprehensive care pathways, but the effectiveness of these pathways is not yet clear. Hence the objective of this study is to compare the clinical effectiveness of a comprehensive care pathway with care as usual on self-reported limitations in Activities of Daily Living.

Methods/Design

A controlled trial will be conducted in which the comprehensive care pathway of University Medical Center Groningen will be compared with care as usual in two other, nonacademic, hospitals. In this trial, propensity scores will be used to adjust for differences at baseline between the intervention and control group. Propensity scores can be used in intervention studies where a classical randomized controlled trial is not feasible. Patients aged 60 years and older will be included. The hypothesis is that 15% more patients at University Medical Center Groningen compared with patients in the care-as-usual condition will have recovered at least as well at 6 months follow-up to pre-fracture levels for Activities of Daily Living.

Discussion

This study will yield new knowledge with respect to the clinical effectiveness of a comprehensive care pathway for the treatment of hip fractures. This is relevant because of the growing incidence of hip fractures and the consequent massive burden on the healthcare system. Additionally, this study will contribute to the growing knowledge of the application of propensity scores, a relatively novel statistical technique to simulate a randomized controlled trial in studies where it is not possible or difficult to execute this kind of design.

Trial registration

Nederlands Trial Register NTR3171

Keywords:
Hip fracture; Care pathway; Propensity score; Elderly; Physical functioning