The authors' reply.

WHO promoted an integrated care model for older people (ICOPE) at the policy, organisation and clinical levels. The integrations between the health systems and among the health service providers are critical for an efficient and high quality service delivery, especially in resource-constrained contexts. Despite the Chinese health system having achieved enormous progress towards ‘health for all’, it is still inadequate to address the health care needs of the growing population of older people, particularly in regard to meeting the needs of those suffering hip fracture after falls due to: (i) high fragmentation of services to provide a full continuum of care for older people; (ii) a health care workforce with major capacity challenges in relation to quantity, quality and equitable distribution; and (iii) fragmented and poor inter-operability of health information systems. The co-management care, co-led by orthopaedic surgeons and geriatricians with the participation of other disciplines, was a successful example to streamline the health service delivery provided to the older hip fracture patients in the Chinese acute hospital. This integrated care model also demonstrated its potential to reduce the risk of patients’ one-year mortality. We concur with Jain and colleagues that the longitudinal engagement with patients beyond the acute phase is essential to improve patients’ health outcomes through the integrated practice units (IPU). In addition, with the emerging development of the digital technologies, there might be a promising role for digital health interventions to support the IPU-based orthogeriatric care.

In response to Ho et al.’s comments, health workforce is the cornerstone to deliver integrated care as addressed in ICOPE. Despite geriatric medicine is under-developed in China, with only approximate one quarter of hospitals above the primary health care level being equipped with a geriatric medicine department in Beijing,, a task-shifting model was adopted in our study. The Emergency Department physicians provided all essential assessments prior to the admission to the orthogeriatric ward, where geriatricians started to conduct pre- and post-operative management. Although task-shifting approach has been widely applied to combat the HIV/AIDS epidemics and to improve health outcomes for maternal and child health, its role to provide the provision of integrate care for older people remains unclear. The co-management care model utilised a “plug-and-play” solution to mobilise the health workforce in the Emergency Department to respond to the shortage of geriatricians.

In summary, with hip fracture becoming a major public health issue in China and many developing countries, we provided the following recommendations for future research. First, IPU-based orthogeriatric care, expanding to post-discharge rehabilitation at the primary health care levels; Second, flexible “plug-and-play” health workforce approach within the hospitals and the communities, particularly to engage non-physician health workers in providing long-term rehabilitation services; Lastly, the role of digital technologies to provide integrated care for older hip fracture patients, examples include training and mobilising health workforce, providing evidence-based decision support system, monitoring quality and performance, referring patients to the suitable health institutions when necessary and sharing patients’ medical information governed by relevant regulations.

Declaration of interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.