A cost-effectiveness study of a patient-centred integrated care pathway

The aim of the study was to compare costs and consequences for an integrated care pathway intervention group with those of a usual care group for patients admitted with hip fracture.

Rehabilitation for patients with hip fracture consists of training in hospital and/or in a rehabilitation unit, and on their own at home with assistance from community care staff. It is important for hospitals to provide methods of care that can safeguard these older patients' physical function and potential for independent living.

A consecutive sample of 112 independently living participants, aged 65 years or older and admitted to hospital with a hip fracture, were included in the study. Data were collected over an 18-month period in 2003-2005. A cost-effectiveness analysis was performed to compare an integrated care pathway intervention (treatment A) with usual care (treatment B).

There was a 40% reduction for each participant in the average total cost of treatment A of euro 9685 vs. euro 15,984 for treatment B. Moreover, clinical effectiveness was much improved. The cost-effectiveness ratio for treatment A was euro 14,840 vs. euro 31,908 for treatment B. In addition, 75% of the participants in treatment A were successfully rehabilitated vs. 55% in treatment B.

The recovery trajectory for hip fracture surgery may be shortened if nurses pay more attention to the individual patient's resources and motivation for rehabilitation. The application of an integrated care pathway with individualized care appears to enhance both rehabilitation outcomes and cost-effectiveness.