HIPCARE: A cluster randomised controlled trial with embedded process evaluation to investigate the clinical and cost effectiveness of multidisciplinary care in the management of patients with a fracture of the hip

Hip fractures are the most common type of fractures among the elderly and are associated with high mortality and poor quality of life. The outcomes of hip fractures are poorer in low-and-middle income countries (LMICs) compared to high-income countries (HIC) due to lack of healthcare resources. With introduction of multidisciplinary care package for treating patients of hip fractures, HICs have showed reduction in burden of hip fractures. This package brings together different healthcare professionals with defined roles to work collectively as a team for providing timely, adequate, and quality treatment for managing hip fracture patients. This includes early surgery to fix the hip fracture, health assessment by specialists and early walking with help of help of a healthcare worker. With limited resources and weak medical systems in LMICs like India, introducing such multidisciplinary packages can play a significant role in bringing down the rapidly increasing burden of hip fractures.

From India, eight sites will be recruited to test this package, where half the hospitals will have the HIPCARE intervention and half continue with their usual care. Patients from ’usual care’ and ‘HIPCARE’ hospitals will be asked to report their health-related quality of life before their injury and again 4 months after. Information about cost of the treatment and any care they receive in the 4 months after their injury will also be collected.

Through this study, we aim to test such a package (HIPCARE package) in five LMICs, including India. The study will test if there will be a difference between quality of life (primary outcome), number of deaths, other health related problems and complications and percentage of patients returning home after hospitalisation, who will receive this package and those will be receive usual care given in hospitals. We will also compare overall resource implications and cost effectiveness of both care pathways for management of hip fractures in elderly.

We also aim to conduct a ‘process evaluation’ using a collection of both quantitative and qualitative data to assess the success/failure of the package, its perceived impact, and possibility of adopting such a package for treating and caring for old people with hip fracture. This will include speaking with senior doctors, administrators, managers, members of the multidisciplinary team, patients and their carers.