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      Reflections on Hip Fracture Recovery From Older Adults Enrolled in a Clinical Trial

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          Abstract

          This study describes patients’ perspectives on recovery during participation in a randomized controlled trial that tested a postoperative hip fracture management program (B4 Clinic), compared with usual care, on mobility. Semistructured qualitative interviews were conducted with 50 older adults with hip fracture (from both groups) twice over 12 months. A total of 32 women (64%) and 18 men (36%) participated in the study with a mean age at baseline of 82 (range = 65-98) years. A total of 40 participants reported recovery goals at some point during their recovery from hip fracture but only 18 participants realized their goals within 12 months. Recovering mobility, returning to prefracture activities, and obtaining stable health were the most commonly reported goals. Participants described good social support, access to physiotherapy, and positive perspective as most important to recovery. These factors were influenced by participants’ knowledge, resources, and monthly contact with study staff (perceived as a form of social support). The most frequently reported barriers to participants’ recovery were the onset of complications, pain, and limited access to physiotherapy. Potential implications of these findings include design and modification of new or preexisting fracture programs, prioritizing patient engagement and enhanced knowledge for future clinical research in hip fracture recovery.

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          Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs.

          Persons with continuous complex care needs frequently require care in multiple settings. During transitions between settings, this population is particularly vulnerable to experiencing poor care quality and problems of care fragmentation. Despite how common these transitions have become, the challenges of improving care transitions have received little attention from policy makers, clinicians, and quality improvement entities. This article begins with a definition of transitional care and then discusses the nature of the problem, its prevalence, manifestations of poorly executed transitions, and potentially remediable barriers. Necessary elements for effective transitions are then presented, followed by promising new directions for quality improvement at the level of the delivery system, information technology, and national health policy. The article concludes with a proposed research agenda designed to advance the science of high-quality transitional care.
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            From patient education to patient engagement: implications for the field of patient education.

            Advances in health care require that individuals participate knowledgeably and actively in their health care to realize its full benefit. Implications of these changes for the behavior of individuals and for the practice of patient education are described. An "engagement behavior framework" (EBF) was compiled from literature reviews and key informant interviews. To assess the focus of research and interventions on the identified engagement behaviors, the EBF was used to code scientific sessions in professional conferences relevant to patient education in the US in 2006-2007. Many specific behaviors constitute engagement. Professional conferences on patient education show only modest attention to the full range of relevant behaviors. People must make informed choices about insurance and clinicians, coordinate communications among providers and manage complex treatments on their own. Not doing so risks preventable illness, suboptimal outcomes and wasted resources. Increased responsibilities of individuals, sick and well, to find and actively participate in high quality health care provides an opportunity for patient education researchers and clinicians to improve health outcomes by developing innovative strategies to support all individuals to effectively participate in their care to the extent possible. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.
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              Economic implications of hip fracture: health service use, institutional care and cost in Canada.

              As the burden of illness associated with hip fracture extends beyond the initial hospitalization, a longitudinal 1 year cohort study was used to analyze levels of health service use, institutional care and their associated costs, and to examine patient and residency factors contributing to overall 1 year cost. Patients in the study were aged 50 year and over, and had been admitted to an acute care facility for hip fracture in the Hamilton-Wentworth region of Canada from 1 April 1995 to 31 March 1996. Health care resources assessed included initial hospitalization, rehospitalization, rehabilitation, chronic care, home care, long-term care (LTC) and informal care. Regression analysis was used to determine the effects of age, gender, residence, survival and days of follow-up on 1 year cost. The mean 1 year cost of hip fracture for the 504 study patients was 26,527 Canadian dollars (95% Cl: $24,564-$28,490). One year costs were significantly different for patients who returned to the community ($21,385), versus those who were transferred to ($44,156), or readmitted to LTC facilities ($33,729) (p < 0.001). Initial hospitalization represented 58% of 1 year cost for community-dwelling patients, compared with 27% for LTC residents. Only 59.4% of community-dwelling patients resided in the community 1 year following hip fracture, and 5.6% of patients who survived their first fracture experienced a subsequent hip fracture. Linear regression indicated place of residence, age and survival were all important contributors to 1 year cost (p < 0.001). While the average 1 year cost of care was $26,527, the overall cost varied depending on a patient's place of residence, age, and survival to 1 year. Annual economic implications of hip fracture in Canada are $650 million and are expected to rise to $2.4 billion by 2041.
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                Author and article information

                Journal
                Gerontol Geriatr Med
                Gerontol Geriatr Med
                GGM
                spggm
                Gerontology and geriatric medicine
                SAGE Publications (Sage CA: Los Angeles, CA )
                2333-7214
                20 March 2017
                Jan-Dec 2017
                : 3
                : 2333721417697663
                Affiliations
                [1 ]The University of British Columbia, Vancouver, Canada
                [2 ]Freie Universität Berlin, Germany
                [3 ]University of Calgary, Alberta, Canada
                [4 ]Providence Health Care, Vancouver, British Columbia, Canada
                Author notes
                [*]Maureen C. Ashe, Department of Family Practice, Centre for Hip Health and Mobility, The University of British Columbia, 7F-2635 Laurel Street, Robert H.N. Ho Research Centre, Vancouver, British Columbia, Canada V5Z 1M9. Email: maureen.ashe@ 123456ubc.ca
                Article
                10.1177_2333721417697663
                10.1177/2333721417697663
                5433673
                28540341
                d421b8ea-1c59-4ac8-83f7-e21d46cb9b4f
                © The Author(s) 2017

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License ( http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 6 June 2016
                : 11 November 2016
                : 1 February 2017
                Categories
                Article
                Custom metadata
                January-December 2017

                recovery,older adults,physiotherapy,goal setting
                recovery, older adults, physiotherapy, goal setting

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