INTRODUCTION: The effectiveness of integrated care pathways for hip fractures in subacute rehabilitation settings is not known. The study objective was to assess if a hip fracture integrated care pathway at a subacute rehabilitation facility would result in better functional outcomes, shorter length of stay and fewer institutionalisations. MATERIALS AND METHODS: A randomised controlled trial on an integrated care pathway for hip fracture patients in a subacute rehabilitation setting. Modified Barthel Index, ambulatory status, SF-12, length of stay, discharge destination, hospital readmission and mortality were measured. Followup assessments were up to 1 year post-hip fracture. RESULTS: There were no significant differences in Montebello Rehabilitation Factor Scores and proportions achieving premorbid ambulatory status at discharge, 6 months and 12 months respectively. There was a significant reduction in the median length of stay between the control group at 48.0 days and the intervention group at 35.0 days (P = 0.009). The proportion of readmissions to acute hospitals was similar in both groups up to 1 year. There were no significant differences for nursing home stay up to 1 year post-discharge and mortality at 1 year. CONCLUSION: Our study supports the use of integrated care pathways in subacute rehabilitation settings to reduce length of stay whilst achieving the same functional gains.
RCT Entities:
INTRODUCTION: The effectiveness of integrated care pathways for hip fractures in subacute rehabilitation settings is not known. The study objective was to assess if a hip fracture integrated care pathway at a subacute rehabilitation facility would result in better functional outcomes, shorter length of stay and fewer institutionalisations. MATERIALS AND METHODS: A randomised controlled trial on an integrated care pathway for hip fracturepatients in a subacute rehabilitation setting. Modified Barthel Index, ambulatory status, SF-12, length of stay, discharge destination, hospital readmission and mortality were measured. Followup assessments were up to 1 year post-hip fracture. RESULTS: There were no significant differences in Montebello Rehabilitation Factor Scores and proportions achieving premorbid ambulatory status at discharge, 6 months and 12 months respectively. There was a significant reduction in the median length of stay between the control group at 48.0 days and the intervention group at 35.0 days (P = 0.009). The proportion of readmissions to acute hospitals was similar in both groups up to 1 year. There were no significant differences for nursing home stay up to 1 year post-discharge and mortality at 1 year. CONCLUSION: Our study supports the use of integrated care pathways in subacute rehabilitation settings to reduce length of stay whilst achieving the same functional gains.
Authors: Akshay Sood; Firas Abdollah; Jesse D Sammon; Victor Kapoor; Craig G Rogers; Wooju Jeong; Dane E Klett; Julian Hanske; Christian P Meyer; James O Peabody; Mani Menon; Quoc-Dien Trinh Journal: World J Urol Date: 2015-04-25 Impact factor: 4.226
Authors: Toby O Smith; Anthony W Gilbert; Ashwini Sreekanta; Opinder Sahota; Xavier L Griffin; Jane L Cross; Chris Fox; Sarah E Lamb Journal: Cochrane Database Syst Rev Date: 2020-02-07