Feasibility, acceptability, and preliminary effects of PATH FOR timely transfer of geriatric HIP fracture patients from hospital to rehabilitation to home (PATH4HIP): a mixed methods study
Innovative Approaches to Care Delivery, Public Health, and Equity, Diversity & Inclusion
Hip fractures are sentinel events for older adults, yet in Ontario access to geriatric rehabilitation following a hip fracture is inconsistent. In our research, we have demonstrated that it is feasible and acceptable to transfer hip fracture patients to geriatric rehabilitation on or before post operative day (POD) 6 via the PATH4HIP. The theory-based design of this pathway will increase spread via identification of monitoring metrics, low cost due to the use of existing resources, and an emphasis on best practices. PATH4HIP promotes the earlier discharge of hip fracture patients from acute care and therefore enhances the utilization of surgical beds. An equally important outcome is improved equity in hip fracture patients’ access to geriatric rehabilitation without negatively affecting rehabilitation metrics.
In this study, we piloted PATH4HIP with post-operative hip fracture patients to facilitate earlier transition (POD 6) from hospital to rehabilitation. A barriers and facilitator analysis (TOH-19-006) informed the design of the evidence-based pathway. Methods: We used the RE-AIM framework to evaluate the feasibility, acceptability and preliminary effects of PATH4HIP using both quantitative and qualitative data. Results: Between January and September 2022, 317 hip fracture patients were screened and 152 patients met the study eligibility criteria. 76.97% (n=117/152) of eligible patients agreed to participate (goal #1: >75%). Patient length of stay in rehabilitation did not increase as a result of earlier acute care discharge. Functional gains made in rehabilitation, percentage discharged to the community and 30-day return rate to ED remained comparable to previously reported outcome data. Adoption was high during the study with 76.92% (n=90/117) of the eligible patients completing the pathway. PATH4HIP was implemented with minimal protocol variations with 48.89% (n=44) discharged from acute care by post-operative day 6 (goal #2: >75%). This increased to 74.44 % (n=67/90) when COVID impacts on transfers to rehabilitation were considered. Overall, participants reported that the PATH4HIP intervention was acceptable. Conclusion: The study confirmed the feasibility and acceptability of the pathway, without negatively affecting key rehabilitation outcomes. The PATH4HIP design prioritized best practices for hip fracture post-operative care and collaboration across health care sectors. This intervention was low cost as it used existing resources to improve use of surgical beds, while increasing timely access to rehabilitation. Challenges included privacy of patient data sets across two organizations, COVID impacts on transfers to rehabilitation and staff turnover in acute care. Steps are underway to ensure the sustainability of PATH4HIP across both campuses.
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