HITH4HIPs: a feasibility trial of hospital in the home after hip fracture

Abstract

In Australia, as in many other jurisdictions, people with low-trauma hip fractures often stay in hospital for extended periods, even when medically stable, increasing risk of hospital-related complications and increasing healthcare costs. In this context, we sought to determine the feasibility of a targeted hospital-in-the-home program following low-trauma hip fracture (LTHF). We conducted a prospective, quasi-experimental (consumer-choice) feasibility study at a tertiary metropolitan hospital, [ANONYMISED], Australia. All local community-dwelling patients with LTHF, 22/7/24–30/11/24, planning return to the community, were potentially eligible for inclusion. The intervention comprised a multidisciplinary early supported physical hospital discharge program (HITH4Hips) delivered to eligible patients who agreed to participation; the control comprised those who were eligible but declined. Primary feasibility and several secondary outcomes were mapped to select elements of the validated RE-AIM framework: reach (characteristics, initial eligibility at screening and final eligibility [able to transfer], consent), effectiveness (‘success rate’, length of stay LOS (acute, and physical in-hospital), hospital-acquired complications (HACs), opioid consumption; patient-reported pain control, health-related quality of life [EQ-Today], falls efficacy, experience measures, health service use, medication costs), patient acceptability, implementation (carer burden, fidelity). Adoption and maintenance outcomes were explored qualitatively, and reported separately. Amongst 101 patients with LTHF screened, 42/101 were initially eligible, 32/101 remained HITH-eligible, 22/32 consented (chose HITH4Hips). Of these, 19/22 consenting transferred onto HITH4Hips (mean age 77.6 years, 53% female), while 10 potentially eligible patients declined HITH4Hips (mean age 81.6 years, 90% female). Overall, 18/19 HITH4Hips patients successfully remained in HITH; one patient represented to hospital while on HITH4Hips, following a fall. Overall, 95% (18/19) patients reported HITH4Hips’ quality of treatment and care was good/very good. Carer burden was mostly reported as nil/low. Mean number of days on HITH4Hips was 5.3 days (95% CI 4.0-6.6); total length of stay was 14.5 (95% CI 12.7 to 16.4) for HITH4Hips patients versus 29 days (95% CI 21.8 to 36.0), and physical ward bed-days 9.1 (95% CI 7.7 to 10.4) days for HITH4Hips patients versus 29 (95% CI 21.8 to 36). Daily opioid consumption was lower and EQ-Today scores higher amongst HITH patients on unadjusted exploratory analyses. This trial met all specified feasibility thresholds in selected eligible patients, including those related to potential reach, effectiveness (within the limits of a pilot program), with satisfactory patient acceptability, supporting the need for large randomised controlled trials of early supported discharge for hip fracture patients. ACTRN12624000886583, registered 19/07/2024.