Mapping care pathways for patients with hip fracture in low- and middle-income countries in South and Southeast Asia

Mapping care pathways for patients with hip fracture in low- and middle-income countries in South and Southeast Asia

Mapping of fragility fracture care pathways and the subsequent identification and reporting of key performance indicators can reduce mortality and improve quality of life for patients, while at the same time reducing healthcare costs. 


This study aims to describe in detail the healthcare resources currently available in low- and middle-income countries in South and Southeast Asia and how hip fracture patients access these resources. This is the first step towards mapping service availability and readiness for hip fracture care in these countries, where care pathways for fragility fracture patients are poorly defined.


The study involved 98 representative hospitals from Malaysia, Thailand, Philippines, Sri Lanka and Nepal. The data for this study were collected from healthcare professionals and managers who completed an online questionnaire with information about pre-hospital care pathways, in-hospital care pathways, discharge information, post-discharge care pathways, and health and social care policies. 

Remarkable results of the study include the following:

• The cost of interventions was predominantly paid for by the individual, except in Sri Lanka and Thailand, where nearly all treatment was reported as being state-funded. 
• The median time between injury and arriving in hospital being less than 12 hours, with the exception of Nepal and the Philippines where the median time to hospital is more than a day.
• Most patients received surgery for their hip fracture, but the median time to surgery varied dramatically between countries, ranging from 2.5 days to 8.0 days.
• Pain scores were routinely recorded in most hospitals, but cognitive assessments were rarely recorded. Falls and bone health assessments were rarely made outside of Malaysia and Thailand.
• The majority of hospitals provided a mobility assessment on the first or second day after surgery, but there was notable variation in postoperative weight-bearing protocols.
• Most hospitals routinely offered patients follow-up appointments in the first six weeks after discharge.


According to Dr. Irewin Tabu, one of the authors of the study: ‘These data provide a baseline assessment of the current care pathways for hip fracture patients in these countries. As care pathways develop, service availability and readiness assessments can be used to track changes from this baseline. Future work is required to determine whether or not changes in pathways of care improve patient outcomes, with an emphasis on patient-reported health-related quality of life.' 

Read the article here.

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