title: Evaluation of the effect of a comprehensive multidisciplinary care pathway for hip fractures: design of a controlled study.
abstract: BACKGROUND
  Hip fractures constitute an economic burden on healthcare resources. Most persons with a hip fracture undergo surgery. As morbidity and mortality rates are high, perioperative care leaves room for improvement. Improvement can be achieved if it is organized in comprehensive care pathways, but the effectiveness of these pathways is not yet clear. Hence the objective of this study is to compare the clinical effectiveness of a comprehensive care pathway with care as usual on self-reported limitations in Activities of Daily Living.
  
  
  METHODS
  A controlled trial will be conducted in which the comprehensive care pathway of University Medical Center Groningen will be compared with care as usual in two other, nonacademic, hospitals. In this trial, propensity scores will be used to adjust for differences at baseline between the intervention and control group. Propensity scores can be used in intervention studies where a classical randomized controlled trial is not feasible. Patients aged 60 years and older will be included. The hypothesis is that 15% more patients at University Medical Center Groningen compared with patients in the care-as-usual condition will have recovered at least as well at 6 months follow-up to pre-fracture levels for Activities of Daily Living.
  
  
  CONCLUSIONS
  This study will yield new knowledge with respect to the clinical effectiveness of a comprehensive care pathway for the treatment of hip fractures. This is relevant because of the growing incidence of hip fractures and the consequent massive burden on the healthcare system. Additionally, this study will contribute to the growing knowledge of the application of propensity scores, a relatively novel statistical technique to simulate a randomized controlled trial in studies where it is not possible or difficult to execute this kind of design.
  
  
  BACKGROUND
  Nederlands Trial Register NTR3171.
authors.affiliation: Department of Surgery-Traumatology, University of Groningen, University Medical Center Groningen, P,O, Box 30,001, 9700 RB, Groningen, The Netherlands. e.r.flikweert@umcg.nl.
authors.forename: Elvira R
authors.initials: ER
authors.lastname: Flikweert
authors.forename: Gerbrand J
authors.initials: GJ
authors.lastname: Izaks
authors.forename: Inge H F
authors.initials: IH
authors.lastname: Reininga
authors.forename: Klaus W
authors.initials: KW
authors.lastname: Wendt
authors.forename: Martin
authors.initials: M
authors.lastname: Stevens
mesh_terms: D000046:Academic Medical Centers; D000203:Activities of Daily Living; D019091:Critical Pathways; D006620:Hip Fractures / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D033183:Interdisciplinary Communication; D008875:Middle Aged; D009426:Netherlands; D010348:Patient Care Team; D015397:Program Evaluation; D057216:Propensity Score; D020127:Recovery of Function; D012107:Research Design; D013997:Time Factors; D016896:Treatment Outcome