Integrated Care Pathway for Hip Fractures in a Subacute Rehabilitation Setting
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 162
- 试验地点
- 2
- 主要终点
- Length of stay in hospital
研究概览
简要总结
The effectiveness of integrated care pathways for hip fractures in sub-acute rehabilitation settings is not known. The study objective was to assess if a hip fracture integrated care pathway at a sub-acute rehabilitation facility would result in better functional outcomes, shorter length of stay and fewer institutionalisations. A randomised controlled trial on an integrated care pathway was conducted for hip fracture patients in a sub-acute rehabilitation setting. The study supports the use of integrated care pathways in sub-acute rehabilitation settings to reduce length of stay whilst achieving the same functional gains.
详细描述
All patients admitted to St Luke's Hospital, a 185-bed hospital in Singapore providing multidisciplinary stepdown care, from 8 September 2004 to 14 June 2006 for the purpose of rehabilitation after a new hip fracture were included. Patients were excluded if any of the following criteria were present: (i) Pre-morbid non-ambulatory status, (ii) nursing home residents, (iii) palliative care patients, and (iv) patients previously enlisted for the trial. Administrative staff allocated patients to either ICP or usual care according to the last digit of their National Registration Identity Card (NRIC) numbers, odd numbers to the intervention group and even numbers to the control group. Patients were then admitted to 1 of 2 intervention wards or 1 of 3 control wards. Patients were enrolled by the principal investigators only after moving into their respective wards because of work flow limitations. Those who refused consent or were excluded remained in their assigned wards and received usual care. Both intervention and control groups were under the care of multidisciplinary teams but the intervention group had structured assessments and checklists in addition to usual care while the control group had usual care alone.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- Single (Outcomes Assessor)
盲法说明
Single Blind
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients admitted to St Luke's Hospital for the purpose of rehabilitation after a new hip fracture.
排除标准
- •Patients were excluded if any of the following criteria were present: (i) Pre-morbid non-ambulatory status, (ii) nursing home residents, (iii) palliative care patients, and (iv) patients previously enlisted for the trial.
研究组 & 干预措施
Control group
Usual care consisted of 2 half hourly therapy sessions per day from Monday to Friday and medical ward rounds 3 times a week. Multidisciplinary rounds were conducted every 2 weeks. Any specific goals or interventions were at the discretion of the managing team.
Intervention group
Intervention group had structured assessments and checklists (as part of the integrated care pathway) in addition to usual care.
干预措施: Care Pathway (Other)
结局指标
主要结局
Length of stay in hospital
时间窗: 1 day At discharge
Refers to the average number of days that patients spend in hospital
Montebello Rehabilitation Factor Score (MRFS)
时间窗: At 1 year
MRFS is a recognised measure of hip fracture patients' functional outcome, calculated with the following formula, using the Modified Barthel Index (MBI) scores (which scores the degree of independence of a subject from any assistance up to a maximum score of 100)
Proportions of patients achieving pre-morbid ambulatory status
时间窗: At 1 year
Pre-morbid ambulatory status is a predictor for post-operative mobility
Percentage of patients admitted to nursing home
时间窗: Up to 1 year after discharge
A form of institutional care
次要结局
- Cumulated mortality(1 year)
- Quality of life scale-Short form 12 quality of life(6 months and 1 year)
- Readmissions to an acute hospital for any reason(up to 1-year post-discharge)
研究者
Boon Yeow, Tan
Chief Executive Officer, Medical Director, Medical Division
St Luke's Hospital, Singapore