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| ID | Type | Description | Link |
|---|---|---|---|
| 65 68953250 | Other Identifier | St Luke's Hospital |
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| Name | Class |
|---|---|
| National University of Singapore | OTHER |
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The effectiveness of integrated care pathways for hip fractures in sub-acute rehabilitation settings is not known. The study objective was to assess if a hip fracture integrated care pathway at a sub-acute rehabilitation facility would result in better functional outcomes, shorter length of stay and fewer institutionalisations. A randomised controlled trial on an integrated care pathway was conducted for hip fracture patients in a sub-acute rehabilitation setting. The study supports the use of integrated care pathways in sub-acute rehabilitation settings to reduce length of stay whilst achieving the same functional gains.
All patients admitted to St Luke's Hospital, a 185-bed hospital in Singapore providing multidisciplinary stepdown care, from 8 September 2004 to 14 June 2006 for the purpose of rehabilitation after a new hip fracture were included. Patients were excluded if any of the following criteria were present: (i) Pre-morbid non-ambulatory status, (ii) nursing home residents, (iii) palliative care patients, and (iv) patients previously enlisted for the trial. Administrative staff allocated patients to either ICP or usual care according to the last digit of their National Registration Identity Card (NRIC) numbers, odd numbers to the intervention group and even numbers to the control group. Patients were then admitted to 1 of 2 intervention wards or 1 of 3 control wards. Patients were enrolled by the principal investigators only after moving into their respective wards because of work flow limitations. Those who refused consent or were excluded remained in their assigned wards and received usual care. Both intervention and control groups were under the care of multidisciplinary teams but the intervention group had structured assessments and checklists in addition to usual care while the control group had usual care alone.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control group | No Intervention | Usual care consisted of 2 half hourly therapy sessions per day from Monday to Friday and medical ward rounds 3 times a week. Multidisciplinary rounds were conducted every 2 weeks. Any specific goals or interventions were at the discretion of the managing team. | |
| Intervention group | Experimental | Intervention group had structured assessments and checklists (as part of the integrated care pathway) in addition to usual care. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Care Pathway | Other | The intervention group had the following as part of the integrated care pathway:
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| Measure | Description | Time Frame |
|---|---|---|
| Montebello Rehabilitation Factor Score (MRFS) | MRFS is a recognised measure of hip fracture patients' functional outcome, calculated with the following formula, using the Modified Barthel Index (MBI) scores (which scores the degree of independence of a subject from any assistance up to a maximum score of 100) | 1 day At discharge |
| Montebello Rehabilitation Factor Score (MRFS) | MRFS is a recognised measure of hip fracture patients' functional outcome, calculated with the following formula, using the Modified Barthel Index (MBI) scores (which scores the degree of independence of a subject from any assistance up to a maximum score of 100) | At 6 months |
| Montebello Rehabilitation Factor Score (MRFS) | MRFS is a recognised measure of hip fracture patients' functional outcome, calculated with the following formula, using the Modified Barthel Index (MBI) scores (which scores the degree of independence of a subject from any assistance up to a maximum score of 100) | At 1 year |
| Proportions of patients achieving pre-morbid ambulatory status | Pre-morbid ambulatory status is a predictor for post-operative mobility | 1 day At discharge |
| Proportions of patients achieving pre-morbid ambulatory status | Pre-morbid ambulatory status is a predictor for post-operative mobility | At 6 months |
| Proportions of patients achieving pre-morbid ambulatory status | Pre-morbid ambulatory status is a predictor for post-operative mobility |
| Measure | Description | Time Frame |
|---|---|---|
| Readmissions to an acute hospital for any reason | An episode when a patient who had been discharged from a hospital is admitted again within a specified time interval | up to 1-year post-discharge |
| Cumulated mortality |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Tze Pin Ng, FAMS, PhD | National University of Singapore | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| St Luke's Hospital, Singapore | Singapore | 659674 | Singapore |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 34766330 | Derived | Handoll HH, Cameron ID, Mak JC, Panagoda CE, Finnegan TP. Multidisciplinary rehabilitation for older people with hip fractures. Cochrane Database Syst Rev. 2021 Nov 12;11(11):CD007125. doi: 10.1002/14651858.CD007125.pub3. |
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| ID | Term |
|---|---|
| D006620 | Hip Fractures |
| ID | Term |
|---|---|
| D005264 | Femoral Fractures |
| D050723 | Fractures, Bone |
| D014947 | Wounds and Injuries |
| D025981 | Hip Injuries |
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| ID | Term |
|---|---|
| D019091 | Critical Pathways |
| ID | Term |
|---|---|
| D010347 | Patient Care Planning |
| D003191 | Comprehensive Health Care |
| D010346 | Patient Care Management |
| D006298 | Health Services Administration |
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Single Blind
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| At 1 year |
| Length of stay in hospital | Refers to the average number of days that patients spend in hospital | 1 day At discharge |
| Percentage of patients admitted to nursing home | A form of institutional care | Up to 1 year after discharge |
Probability or risk of individuals dying from the disease during a specified period
| 1 year |
| Quality of life scale-Short form 12 quality of life | Scale for short form 12 quality of life 0-100 Scale for Physical Component Summary (PCS) and Scale for Mental Component Summary (MCS), a multipurpose, generic measure of health status 0-100 Interpretation of the score : The higher score, the better | 6 months and 1 year |
| D007869 |
| Leg Injuries |