Short summary

The aim of this research project is to develop a hip-fracture-specific Patient Reported Outcome (PRO) tool. The treatment of hip fracture patients is based on a reference program including a number of evidence-based recommendations. Since the perception of what hip fracture patients consider particularly important in treatment, care and rehabilitation is still unclear, an active involvement of patients with hip fractures in the development of a PRO tool is recommended.  Using PRO data in the clinical meeting with the patient may help focusing treatment, care and rehabilitation and eventually improve patients' quality of life.

Rationale

Hip fracture is a severe injury to elderly people, often resulting in reduced mobility and loss of independence. Furthermore, impaired mobility alongside reduced social independence affects patients' quality of life. Using patient-reported outcomes (PRO) on patients' health condition in the clinical meeting may help focusing treatment, care and rehabilitation, and eventually improve patients' quality of life. Besides, at a population level the clinical quality can improve when PRO's are based on patients' preferences and used systematically. The project is expected to contribute to a more patient-centred healthcare system by involving patients' individual assessments and preferences for the future.

In Denmark, approximately 8000 patients aged 65 years or older are treated for hip fractures; ac-counting for 2-3% of the total use of hospital beds. The treatment of these patients is based on a reference program described by an interdisciplinary steering committee of relevant professionals. The program includes a number of generic evidence-based recommendations for care and treatment, such as type of surgery, surgery delay, pain management and prevention of pressure injuries. In order to develop a more patient-centred healthcare system, involving patients' individual assessments and preferences for the future, PRO data can be used advantageously. PRO data concerns patients' assessment of health, including physical and mental health, symptoms, health related quality of life and functional level, and thus, PRO data can focus and improve treatment, care and rehabilitation at a clinical level and improve clinical quality at a population level. Using PRO tools at the individual level shows that overlooked problems can be visualised, symptoms can be reduced, quality of life improved, and communication with and relationship with health professionals improved. Multiple generic and domain specific PRO tools, such as SF-36, EQ-5D and Barthel, are used to evaluate quality of life and health of several types of patients, including hip fracture patients. However, these PRO tools only reveal a range of general health assessments, which may be relevant to several types of patients, but not specifically relevant to elderly patients with hip fracture. Since the perception of what hip fracture patients consider particularly important in treatment, care and rehabilitation and what they consider crucial to their future quality of life is still unclear, an active involvement of patients with hip fractures in the development of a PRO tool is recommended. 

Previously, PRO tools have been used primarily for outpatient consultations and in relation to chronic or long-term patient pathways thus the acute patient pathway and the group of elderly patients are an unexplored field.

The aim of this research project is to develop a hip-fracture-specific PRO tool. 

In cooperation with patients and relatives, patients' preferences for treatment, care and rehabilitation after a hip fracture are identified and described as the basis for the development of the PRO tool. The project includes validation of the tool, a feasibility study regarding use of the tool, as well as subsequent outcome measurements. The project consists of 5 sub-studies. 

Description of the cohort

The interviews will be conducted with patients aged 65 years or older and admitted acute with hip fractures, as well as interviews with dyads of patients and their relatives at the Orthopaedic Surgery Department at Kolding Hospital, a part of the Hospital Lillebaelt.

 The survey will be conducted among all patients aged 65 or older with a hip fracture at the Orthopaedic Surgery Department at Kolding Hospital, a part of the Hospital Lillebaelt and Orthopaedic Surgery Department at Odense University Hospital (OUH).

Data and biological material

Qualitative data using individual interviews and and interviews with dyads of patients and their relatives. 

Questionnaire data using the new PRO-tool developed in this project.

Data from the Danish Multidisciplinary Hip Fracture Registry

Collaborating researchers and departments

The Research Unit of User Perspectives, Department of Public Health, University of Southern Denmark

• Associated Professor Birgitte Nørgaard, MSc , PhD

Department of Orthopaedic Surgery, Kolding Hospital, a part of Hospital Lillebaelt 

• Clinical Associate Professor Bjarke Viberg,  PhD, MD

The Orthopaedic Research Unit at the University of Southern Denmark and Odense University Hospital 

• Professor, Research Manager and Consultant Søren Overgaard