Background:
The course and outcomes of hip fracture patients are often complicated by the presence ofdementia and delirium, referred to as cognitive impairment (CI), which limits access to inpatientrehabilitation. In response to this concern, members of our team developed andpiloted an in-patient rehabilitation model of care (Patient-Care Rehabilitation Model; PCRM)targeting patients with hip fracture and CI (PCRM-CI). We are now conducting a 3-yearstudy comparing an inpatient rehabilitation model of care for community dwellingindividuals with hip fracture and CI (PCRM-CI) to usual care to determine whether it resultsin improved mobility at the time of discharge from inpatient rehabilitation.
Methods:
A non-equivalent pre-post design is being used to evaluate the PCRM-CI compared to usualcare. All community dwelling (private home or retirement home) patients following a hipfracture are eligible to participate. Recruitment of both cohorts is taking place at twofacilities. Target accrual is 70 hip fracture patients in the PCRM-CI cohort and 70 patients inthe usual care cohort. We are also recruiting 70 health care providers (HCPs), who are beingtrained to implement the PCRM-CI, and their unit managers. Patient data are collected atbaseline, discharge, and 6 months post-surgery. Evaluations include mobility, physicalfunction, and living arrangement. Additional outcome variables are being collected frommedical records and from the patients via their proxies. Data on the prevalence and severityof dementia and delirium are being collected. Staff data are collected at baseline and one yearafter implementation of the model to determine change in staff knowledge and attitudestoward patients with hip fracture and CI. Bi-monthly semi-structured interviews with unitmanagers have been conducted to examine factors and barriers influencing the modelImplementationData collection began in 2009 and is expected to be completed in 2012. Thecontrol cohort of 70 patients has been recruited, and 45 patients have been accrued to theintervention group to date.DiscussionEvaluation of this model of care is timely given the increasing proportion of persons withcognitive impairment and hip fractures.Trial registrationThe study is registered at https://clinicaltrials.gov/, Identifier NCT01566136.