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The Effect of Care Pathways for Hip Fractures: A Systematic Review

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Abstract

We performed a systematic review for primary studies on care pathways (CPs) for hip fracture (HF). The online databases MEDLINE-PubMed, Ovid-EMBASE, CINAHL-EBSCO host, and The Cochrane Library (Cochrane Central Register of Clinical Trials, Health Technology Assessment Database, NHS Economic Evaluation Database) were searched. Two researchers reviewed the literature independently. Primary studies that met predefined inclusion criteria were assessed for their methodological quality. A total of 15 publications were included: 15 primary studies corresponding with 12 main investigations. Primary studies were evaluated for clinical outcomes, process outcomes, and economic outcomes. The studies assessed a wide range of outcome measures. While a number of divergent clinical outcomes were reported, most studies showed positive results of process management and health-services utilization. In terms of mortality, the results provided evidence for a positive impact of CPs on in-hospital mortality. Most studies also showed a significantly reduced risk of complications, including medical complications, wound infections, and pressure sores. Moreover, time-span process measures showed that an improvement in the organization of care was achieved through the use of CPs. Conflicting results were observed with regard to functional recovery and mobility between patients treated with CPs compared to usual care. Although our review suggests that CPs can have positive effects in patients with HF, the available evidence is insufficient for formal recommendations. There is a need for more research on CPs with selected process and outcome indicators, for in-hospital and postdischarge management of HF, with an emphasis on well-designed randomized trials.

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Acknowledgments

This study was supported by the European Pathway Association (www.E-P-A.org) through an unrestricted educational grant from Pfizer. We hereby acknowledge Pfizer Belgium, Pfizer Italy, Pfizer Ireland, and Pfizer Portugal for providing the unrestricted educational grant. The funding sources played no role in the design, execution, and evaluation of the present study. S. B. is senior clinical investigator of the Fund for Scientific Research, Flanders, Belgium (F.W.O.-Vlaanderen) and holder of the Leuven University Chair in Gerontology and Geriatrics.

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Authors and Affiliations

  1. Department of Clinical and Experimental Medicine, University of Eastern Piedmont “Amedeo Avogadro”, Novara, Italy

    Fabrizio Leigheb & Massimiliano Panella

  2. European Pathway Association, Louvain, Belgium

    Fabrizio Leigheb, Kris Vanhaecht, Walter Sermeus, Cathy Lodewijckx, Svin Deneckere, Steven Boonen, Paulo Alexandre Faria Boto, Rita Veloso Mendes & Massimiliano Panella

  3. School of Public Health, Catholic University Leuven, Louvain, Belgium

    Kris Vanhaecht & Massimiliano Panella

  4. Western Norway Research Network on Integrated Health Care Helse Fonna, Haugesund, Norway

    Kris Vanhaecht

  5. Center for Health Services and Nursing Research, Catholic University of Leuven, Louvain, Belgium

    Walter Sermeus, Cathy Lodewijckx & Svin Deneckere

  6. Leuven University Center for Metabolic Bone Diseases, Louvain, Belgium

    Steven Boonen

  7. Division of Geriatric Medicine, Leuven University Hospitals, Louvain, Belgium

    Steven Boonen

  8. National School of Public Health, Lisbon, Portugal

    Paulo Alexandre Faria Boto & Rita Veloso Mendes

  9. Local Health District of Vercelli, Vercelli, Italy

    Massimiliano Panella

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  1. Fabrizio Leigheb
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Correspondence to Massimiliano Panella.

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Leigheb, F., Vanhaecht, K., Sermeus, W. et al. The Effect of Care Pathways for Hip Fractures: A Systematic Review. Calcif Tissue Int 91, 1–14 (2012). https://doi.org/10.1007/s00223-012-9589-2

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