Understanding Patient and Clinician Perspectives in the HITH4Hips Trial: A Qualitative Study

Early-discharge models for hip fracture care are increasingly used to reduce hospital length of stay and healthcare burden, but stakeholder experiences remain underexplored. This study aimed to explore the experiences of patients, carers and healthcare providers (HCPs) involved in a multidisciplinary Hospital In The Home (HITH4Hips) program for low-trauma hip fractures, and to identify factors influencing its implementation.

Guided by the RE-AIM QuEST (REach, Adoption, Implementation and Maintenance Qualitative Evaluation for Systematic Translation) framework, semi-structured interviews were conducted with stakeholders involved in the HITH4Hips program at a metropolitan trauma hospital in Sydney, Australia. Interviews were transcribed verbatim and analysed using a rapid assessment approach with hybrid inductive-deductive coding. Themes were developed through interpretive analysis.

Nineteen interviews were completed, including 14 patients/carers (10 HITH4Hips participants; four usual care who declined HITH4Hips, mean age 75 years, 64% women, 86% from culturally and linguistically diverse background) and five HCPs. Four themes were developed: (1) Suitability for HITH: patients preferred home-based recovery, whereas HCPs were more risk-averse; (2) Perceptions of program effectiveness: patients prioritised emotional well-being and functional progress, while HCPs emphasised measurable outcomes; (3) HCP mindset and orientation: role ambiguity and variable staff engagement limited program adoption; and (4) Realising program value: siloed communication and weak inpatient-community linkages hindered implementation.

The HITH4Hips program was acceptable and has the potential to reduce healthcare system burden. Successful implementation will require tailored communication strategies and coordinated care pathways to align patient and provider priorities.