Hospital Readmission After HIPr Fracture. Impact of a Territorial Fracture Liason Service

Study Overview
=================
Brief Summary
-----------------
The International Osteoporosis Foundation (IOF) and the American Society for Bone Research and Mineral Metabolism recommend the creation and implementation of fracture coordination services (FLS) as the most efficient way to address the problem. FLS has emerged as a new clinical approach that uses coordinated, multidisciplinary care to improve post-fracture outcomes and reduce recurrent fractures. It is a multidisciplinary and protocolized care model that must guarantee: Identify fragility fractures and people at risk for a fracture Fracture risk assessment Indication for treatment or referral Improvement in therapeutic compliance Reduce the risk of falls It is known that patients who have undergone a FLS model (vs no FLS), have lower mortality, lower risk of fracture, with a reduction of 35% and 56%, respectively, during two years of follow-up. One of the most important objectives of the FLS is the proper recognition and treatment of osteoporosis (OP) in patients with fragility fractures. A major problem is the lack of adherence to treatment for OP, and inclusion in an FLS program increases the prescription of bisphosphonates from 17.9% to 76%. In addition, a specific follow-up program means that 73% of patients followed by FLS continue to undergo anti-resorptive treatment after 2 years of having suffered a femur fracture.

Detailed Description
-----------------
Hypothesis After a femur fracture due to fragility, upon discharge from surgery at the Hospital de la Santa Creu i Sant Pau, including patients in a regional FLS program will make it possible to complete the study of the patient with fracture, improve adherence to treatment of OP (secondary prevention), and obtain better functional recovery.

Official Title
-----------------
Hospital Readmission After HIPr Fracture. Impact of a Territorial Fracture Liason Service

Conditions
-----------------
Hip Fractures

Intervention / Treatment
-----------------
* Other: Fracture Territorial Liaison Service afert a Hip fracture


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: All hip fractures older than 65 years Exclusion Criteria: Politraumatic fractures Metastasic fractures

Ages Eligible for Study
-----------------
Minimum Age: 65 Years
Maximum Age: 99 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Multicenter clinical trial. Adult patients who consult the Hospital Emergency Department (ED) of the Hospital de la Santa Creu i Sant Pau (HSCSP) for an FxF PSM as a primary or secondary diagnosis will be selected and will be randomized with a 1:1 distribution to be included in the FLS -CTSPau (intervention group) or to receive usual care (control group). The result of the intervention will be evaluated in terms of health outcomes (re-consultations, hospital readmissions and quality of life).
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Patiens who will receive stanrdar care after hip fracture<br>All the patients who will be on surgery after a hip fracture will receive after the hospital discharge the standar following we are doing now in our hospital | Other: Fracture Territorial Liaison Service afert a Hip fracture<br>* Give a diferent than the current one way of follow up to the patients with hip fracture<br>|
| Active Comparator: Patiens who will receive FLS following after the hip fracture<br>All the patients who will be on surgery after a hip fracture will receive after the hospital discharge a FLS following, multidisciplinary, with a web and mobile app aplication | Other: Fracture Territorial Liaison Service afert a Hip fracture<br>* Give a diferent than the current one way of follow up to the patients with hip fracture<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Deaths | % of Number of deaths after 1st year o follow up | 1 year after discharge | 
| Number of Falls | Number of Falls 1st year o follow up | 1 year after discharge | 
| Percentage of patients with adequated Osteoporotic treatment | Percentage of patients with adequated osteoporotic treatment | 1 year after discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Barthel at the end of follow up | Compare Barthel after hospital discharge with the end of follow up barthel. Minimum is 0 maximum is 100. | 1 year after discharge |