Title: HIPCARE: a cluster randomised controlled trial with embedded process evaluation
Funder: Department of Health and Social Care

Abstract: Research Question: Does the multidisciplinary HIPCARE training and support package improve quality of life and reduce healthcare costs for patients with hip fracture? Background Older people frequently sustain fractures after falls from a standing height, as their bones are weakened by osteoporosis. These fragility fractures have serious consequences; 25% of hip fracture patients in the UK die within a year and survivors have a reduction in their quality-of-life similar to having a stroke. The outlook is even worse for people in low and middle-income countries (LMIC) with fewer resources to support recovery and long-term care. Many higher-income countries have introduced multidisciplinary care pathways for patients with hip fracture. Multidisciplinary care involves nurses, therapists, surgeons and medical specialists working together with joint responsibilities. Multidisciplinary care has not been tested in LMIC. This proposal is to refine and then test a multidisciplinary care training and support package for patients with hip fracture in LMIC in Asia, to address the RIGHT call 4 by reducing the global burden of unintentional injuries and urgent and emergency care. Aims and objectives Our aim is to improve health-related quality of life for patients following hip fracture and to reduce healthcare costs. The project will have two parts: 1.To refine the multidisciplinary HIPCARE training package taking into account the specific healthcare context of five different LMIC in Asia. 2.To deliver a cluster randomised trial of the HIPCARE training package with embedded process and economic evaluations. Methods Setting: Hospitals in Sri Lanka, India, Philippines, Thailand and Vietnam; 6-8 public hospitals in each LMIC that treat 200+ patients with hip fractures annually. Randomisation: Hospitals will be randomised to HIPCARE or usual care, via a centralised computer-based process stratified by country. Inclusion criteria: Patients 60 years or over having surgery for a hip fracture. Exclusion criteria: Patients not available for follow-up at 120 days. INTERVENTION GROUP: Intervention sites will be provided with a multi-disciplinary intervention training package with online support, which will also outline the metrics of success. CONTROL GROUP: Usual care. All hospitals randomised to the control group will be offered access to the HIPCARE training and support package at the conclusion of the trial. Outcome measures: We will collect the Core Outcome Set for hip fracture trials at 120 days after surgery, the primary outcome measure being Health-related Quality of Life. Timeline The project will commence June 2022 and complete over a 4-year period. A Gannt chart outlining milestones and completion dates has been included. Impact/Dissemination: The impact plan for the HIPCARE trial uses Beckhard s model: Change = (Dissatisfaction + Vision + First steps) > Resistance, where the Change we are seeking is improved quality of life for people suffering hip fracture in LMIC in South Asia. We will use three modes of dissemination: 1. CEI: through plain language summaries specific to each country via social media and web-pages as well as hard-copy 2. Policymakers: through our partnership with the Global Fragility Fracture Network, with its many events worldwide 3. Healthcare professionals: through scientific publications and presentations

Lay abstract: Aim(s) of the research Our aim is to improve quality-of-life for hip fracture patients and to reduce healthcare costs in Low and Middle Income Countries (LMIC) in Asia. Background to the research Older patients are particularly likely to break a bone (fracture) because of a fall from a standing height, as their bones are weakened by osteoporosis. These fragility fractures have serious consequences; in the UK 25% of hip fracture patients die within a year and survivors have a reduction in their quality-of-life similar to having a stroke. Outcomes may be even worse in LMIC without the same level of healthcare resource. Asia is particularly affected by rapidly ageing populations. The number of hip fractures is expected to increase from 1,124,060 now to 2,563,488 in 2050. Associated healthcare cost may rise to US$15 billion. Improving care for patients with hip fracture is therefore a priority in this region. Looking after patients following a hip fracture requires healthcare workers from many different backgrounds to work together. These include surgeons, doctors specialising in looking after older patients, nurses and therapists, each with defined roles and responsibilities. In the UK, this team approach has reduced the number of patients dying and improved quality-of-life after hip fracture. It also reduced time spent in hospital and associated healthcare costs . This study is about testing the benefits of such multidisciplinary care in LMIC in Asia. Design and methods The project will have two parts: 1. To refine the multidisciplinary HIPCARE training and support package for each LMIC. 2. To see if the HIPCARE intervention improves the quality-of-life for hip fracture patients in LMIC and whether it reduces healthcare costs, compared with usual care. The HIPCARE training package has three main components: early surgery to fix the hip fracture, early assessment by a medical doctor and early walking with the help of a therapist to speed recovery. Having refined the training materials to make HIPCARE specific to each country, we will do a large study to compare HIPCARE with usual care in 40 hospitals in LMIC. Community engagement This proposal has been developed together with members of the Global Health Fragility Fractures Community Engagement and Involvement Panel with support from the World Musculoskeletal Trauma Patient and Public Involvement Group. The views of patients and their carers, from Asia and the UK, informed all aspects of the study but in particular the choice of eligibility criteria, primary outcome measure and follow-up plan. Dissemination We disseminate the findings of this study: 1. Through plain language summaries specific to each country via social media/web-pages as well as hard-copy 2. Through our partnership with the Global Fragility Fracture Network, with its many events worldwide 3. Through scientific publications and presentations

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: MUSCULOSKELETAL