title: The development of a comprehensive multidisciplinary care pathway for patients with a hip fracture: design and results of a clinical trial.
abstract: BACKGROUND
  Hip fractures frequently occur in older persons and severely decrease life expectancy and independence. Several care pathways have been developed to lower the risk of negative outcomes but most pathways are limited to only one aspect of care. The aim of this study was therefore to develop a comprehensive care pathway for older persons with a hip fracture and to conduct a preliminary analysis of its effect.
  
  
  METHODS
  A comprehensive multidisciplinary care pathway for patients aged 60 years or older with a hip fracture was developed by a multidisciplinary team. The new care pathway was evaluated in a clinical trial with historical controls. The data of the intervention group were collected prospectively. The intervention group included all patients with a hip fracture who were admitted to University Medical Center Groningen between 1 July 2009 and 1 July 2011. The data of the control group were collected retrospectively. The control group comprised all patients with a hip fracture who were admitted between 1 January 2006 and 1 January 2008. The groups were compared with the independent sample t-test, the Mann-Whitney U-test or the Chi-squared test (Phi test). The effect of the intervention on fasting time and length of stay was adjusted by linear regression analysis for differences between the intervention and control group.
  
  
  RESULTS
  The intervention group included 256 persons (women, 68%; mean age (SD), 78 (9) years) and the control group 145 persons (women, 72%; mean age (SD), 80 (10) years). Median preoperative fasting time and median length of hospital stay were significantly lower in the intervention group: 9 vs. 17 hours (p < 0.001), and 7 vs. 11 days (p < 0.001), respectively. A similar result was found after adjustment for age, gender, living condition and American Society of Anesthesiologists (ASA) classification. In-hospital mortality was also lower in the intervention group: 2% vs. 6% (p < 0.05). There were no statistically significant differences in other outcome measures.
  
  
  CONCLUSIONS
  The new comprehensive care pathway was associated with a significant decrease in preoperative fasting time and length of hospital stay.
authors.affiliation: University of Groningen, Department of Surgery-Traumatology, University Medical Center Groningen, PO Box 300001, Groningen 9700 RB, 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: Bas A S
authors.initials: BA
authors.lastname: Knobben
authors.forename: Martin
authors.initials: M
authors.lastname: Stevens
authors.forename: Klaus
authors.initials: K
authors.lastname: Wendt
mesh_terms: D000203:Activities of Daily Living; D000359:Aftercare; D000776:Anesthesiology; D019091:Critical Pathways; D003693:Delirium / Q000209:etiology / Q000517:prevention & control; D004630:Emergencies; D005215:Fasting; D005260:Female; D005265:Femoral Neck Fractures / Q000451:nursing / Q000534:rehabilitation / Q000601:surgery*; D005853:Geriatrics; D006620:Hip Fractures / Q000451:nursing / Q000534:rehabilitation / Q000601:surgery*; D065386:Historically Controlled Study / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D033183:Interdisciplinary Communication; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes; D009985:Orthopedics; D010044:Outpatient Clinics, Hospital; D010348:Patient Care Team; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D020127:Recovery of Function; D012107:Research Design; D016896:Treatment Outcome