Advances in Hip Fracture Care Delivery – A West Coast Perspective

Pierre Guy, Dolores Langford, Maureen C. Ashe

It has been a busy time in British Columbia as we move forward with several projects related to recovery for older adults after hip fracture. In particular, there are several provincial and local initiatives which we highlight in this update.

Dr. Pierre Guy is leading the Hip Fracture Redesign Project throughout British Columbia. This project, funded through the Doctors of BC (formerly British Columbia Medical Association) Specialist Services Committee, is nearing completion of Phase 1. The focus of this phase is to improve quality of the care (access, efficiency, efficacy, safety, appropriateness) by establishing consistent care pathways, for hip fracture recovery, within eight hospitals across the province. Many thanks go to the individual hospitals sites who are working hard to make the transition to the new pathways and collect data to assure the success of the Redesign Project.

Patient-centered health communication for older adults after hip fracture is key. Therefore, we developed a new toolkit, Fracture Recovery for Seniors at Home (FReSH Start), inspired by older adults with hip fracture who asked for more information to navigate discharge from hospital. The FReSH Start project has evolved over the past six months with input from collaborators around the province through the BC Hip Redesign which charged Ms. Valerie MacDonald to coordinate. The toolkit is currently being evaluated by approximately 30 older adults and/or their family members in order to provide constructive feedback before we commence the implementation phase in the Fall of 2014. Support for the toolkit has been provided through a number of funding agencies including the VGH and UBC Hospital Foundation and the Specialist Services Committee. We are also grateful for the ongoing support from the Center for Hip Health and Mobility, in Vancouver.

In August 2014, we will see the completion of two randomized controlled trials (RCT) testing interventions for older adults after hip fracture. The CIHR funded B4 Study led by Dr. Maureen Ashe is an RCT testing the effect on mobility of a fracture follow-up clinic for older adults after hip fracture. The intervention includes a comprehensive geriatric assessment, in addition to out-patient physiotherapy, occupational therapy and/or other health professionals, as deemed appropriate. The clinic is led by Dr. Wendy Cook and her colleagues at St. Paul’s Hospital in Vancouver. The final assessment will occur in August 2014 and we look forward to sharing the results of the study. Nonetheless, there have been many lessons learned, some of which have guided a second study called “Back to the Future”. This feasibility study is led by Ms. Dolores Langford, a PT leader at Vancouver Coastal Health, and supported by a Vancouver Coastal Health Research Institute Team Grant and the North Shore Health Research Foundation. We are testing feasibility of delivering the FReSH Start toolkit plus up to five follow-up phone calls by a physiotherapist within the first four months after hip fracture. This Fall will be a busy time, as we disseminate results from both studies.

In summary, it has been a very productive and collaborative past 12 months in BC. Our team, and provincial collaborators, have benefitted greatly from the guidance of older adults and their family members. Our ultimate goal is to improve care delivery, and enhance the recovery experience for older adults and their family members after hip fracture.