title: Protocol-based management of older adults with hip fractures in Delhi, India: a feasibility study.
abstract: BACKGROUND
  Worldwide hip fractures are projected to increase from 1.7 million in 1990 to 6.3 million in 2050. In India, conservative estimates suggest an annual incidence of 600,000 osteoporotic hip fractures and this is expected to increase significantly due to ageing and increase life expectancy. Protocol-based 'care pathways' for the management of adults, over 60 years of age, with hip fractures in high-income countries has resulted in decreased mortality rates, early hospital discharge, improved quality of life and reduction in healthcare costs. The study objectives are to determine appropriateness, acceptability and feasibility of adopting best-practice guideline or protocol-based care for the management of hip fractures among older adults in India. The study will also identify barriers and facilitators in recruiting patients and retention till the agreed follow-up period.
  
  
  METHODS
  This will be a mixed-methods prospective cohort study. The quantitative data collection will involve recruitment of consecutive patients aged >50 years with an X-ray-confirmed hip fracture admitted in four tertiary care hospitals in Delhi, India, over a 2-month period. The quantitative data will be collected at three points: from patients at admission to hospital, from medical records at discharge and by telephone interviews with patients at 30 days post hip fracture. Qualitative data collection will involve key informant interviews, conducted with clinical leads and focus group discussions, conducted with groups of healthcare providers and patients and/or their carers. COM-B theoretical framework (capability, opportunity, motivation and behaviour) will be used to explore healthcare providers' behaviour in order to facilitate development and implementation of appropriate integrated care pathway for management of older adults with hip fractures in India.
  
  
  CONCLUSIONS
  The proposed study will identify gaps in best practice in the management of older people with hip fractures in tertiary care hospitals in Delhi and document barriers and facilitators to the implementation of protocol-based care through recording the contextual realities of the health systems and care-seeking behaviours. Insights into these factors will be used to facilitate the development of protocol-based management of older people with hip fractures that is appropriate, context specific and acceptable by stakeholders in a low- and middle-income country setting, such as India.
authors.affiliation: The George Institute for Global Health, 219-221, Splendor Forum, Plot No. 3, Jasola District Centre, New Delhi, 110025 India.
authors.forename: Lalit
authors.initials: L
authors.lastname: Yadav
authors.affiliation: The George Institute for Global Health, 219-221, Splendor Forum, Plot No. 3, Jasola District Centre, New Delhi, 110025 India.
authors.forename: Abha
authors.initials: A
authors.lastname: Tewari
authors.affiliation: Department of Orthopaedics, University College of Medical Sciences, New Delhi, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Jain
authors.affiliation: The George Institute for Global Health, Sydney, Australia.
authors.forename: Beverley
authors.initials: B
authors.lastname: Essue
authors.affiliation: Primary Health Care Research, The George Institute for Global Health & Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Peiris
authors.affiliation: Epidemiology & Biostatistics, The George Institute for Global Health & Statistics & Epidemiology, University of Oxford, Oxford, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
authors.affiliation: Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
authors.forename: Prakash
authors.initials: P
authors.lastname: Kotwal
authors.affiliation: The George Institute for Global Health & Geriatric Medicine, Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Lindley
authors.affiliation: Health Economics, The George Institute for Global Health & Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Jan
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Tracey
authors.initials: T
authors.lastname: Chantler
authors.affiliation: Nuffield Department of Population Sciences, School of Public Health, University of Oxford, Oxford, UK.
authors.forename: Premila
authors.initials: P
authors.lastname: Webster
authors.affiliation: The George Institute for Global Health, University of Oxford, Oxford, UK.|The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Robyn
authors.initials: R
authors.lastname: Norton
authors.affiliation: Global Surgery, The George Institute for Global Health, University of Oxford, Oxford, OX1 3BD UK.
authors.forename: Santosh
authors.initials: S
authors.lastname: Rath
keywords: Feasibility; Hip fracture; Mixed methods; Older adults; Protocol-based care