The University of Oxford

Aim(s) of the research Our aim is to improve quality-of-life for hip fracture patients and to reduce healthcare costs in Low and Middle Income Countries (LMIC) in Asia. Background to the research Older patients are particularly likely to break a bone (fracture) because of a fall from a standing height, as their bones are weakened by osteoporosis. These fragility fractures have serious consequences; in the UK 25% of hip fracture patients die within a year and survivors have a reduction in their quality-of-life similar to having a stroke. Outcomes may be even worse in LMIC without the same level of healthcare resource. Asia is particularly affected by rapidly ageing populations. The number of hip fractures is expected to increase from 1,124,060 now to 2,563,488 in 2050. Associated healthcare cost may rise to US$15 billion. Improving care for patients with hip fracture is therefore a priority in this region. Looking after patients following a hip fracture requires healthcare workers from many different backgrounds to work together. These include surgeons, doctors specialising in looking after older patients, nurses and therapists, each with defined roles and responsibilities. In the UK, this team approach has reduced the number of patients dying and improved quality-of-life after hip fracture. It also reduced time spent in hospital and associated healthcare costs . This study is about testing the benefits of such multidisciplinary care in LMIC in Asia. Design and methods The project will have two parts: 1. To refine the multidisciplinary HIPCARE training and support package for each LMIC. 2. To see if the HIPCARE intervention improves the quality-of-life for hip fracture patients in LMIC and whether it reduces healthcare costs, compared with usual care. The HIPCARE training package has three main components: early surgery to fix the hip fracture, early assessment by a medical doctor and early walking with the help of a therapist to speed recovery. Having refined the training materials to make HIPCARE specific to each country, we will do a large study to compare HIPCARE with usual care in 40 hospitals in LMIC. Community engagement This proposal has been developed together with members of the Global Health Fragility Fractures Community Engagement and Involvement Panel with support from the World Musculoskeletal Trauma Patient and Public Involvement Group. The views of patients and their carers, from Asia and the UK, informed all aspects of the study but in particular the choice of eligibility criteria, primary outcome measure and follow-up plan. Dissemination We disseminate the findings of this study: 1. Through plain language summaries specific to each country via social media/web-pages as well as hard-copy 2. Through our partnership with the Global Fragility Fracture Network, with its many events worldwide 3. Through scientific publications and presentations