• Vol. 42 No. 11, 579–584
  • 15 November 2013

Integrated Care Pathway for Hip Fractures in a Subacute Rehabilitation Setting

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ABSTRACT

Introduction: The effectiveness of integrated care pathways for hip fractures in subacute rehabilitation settings is not known. The study objective was to assess if a hip fracture integrated care pathway at a subacute rehabilitation facility would result in better functional outcomes, shorter length of stay and fewer institutionalisations.

Materials and Methods: A randomised controlled trial on an integrated care pathway for hip fracture patients in a subacute rehabilitation setting. Modified Barthel Index, ambulatory status, SF-12, length of stay, discharge destination, hospital readmission and mortality were measured. Followup assessments were up to 1 year post-hip fracture.

Results: There were no significant differences in Montebello Rehabilitation Factor Scores and proportions achieving premorbid ambulatory status at discharge, 6 months and 12 months respectively. There was a significant reduction in the median length of stay between the control group at 48.0 days and the intervention group at 35.0 days (P = 0.009). The proportion of readmissions to acute hospitals was similar in both groups up to 1 year. There were no significant differences for nursing home stay up to 1 year post-discharge and mortality at 1 year.

Conclusion: Our study supports the use of integrated care pathways in subacute rehabilitation settings to reduce length of stay whilst achieving the same functional gains.


Hip fractures are an increasingly common problem and a significant cause of mortality, morbidity and functional dependence. The incidence of hip fracture has increased in recent decades in countries with ageing populations and Singapore is no exception. Hip fracture incidence rates in Singapore have risen rapidly over the past 30 to 40 years,
particularly in women, and are among the highest in Asia. The age-adjusted hip fracture rates amongst Singapore residents aged 50 years and over for 1991 to 1998 (per 100,000) were 152 in men and 402 in women.

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