Hip fractures in the elderly are a serious health concern globally and in Thailand. However, due to limited resources, the care services provided for this condition in Thailand still need to align with the international standard. To address this issue, the SIHP initiated a project in collaboration with the Healthcare Accreditation Institute (HAI) to improve the clinical practice guidelines for this patient population. The pilot hospitals were invited to participate in the project and incorporate the guidelines into their practices. To study the problem and suggest solutions, the SIHP also received research funding from the Health Systems Research Institute (HSRI), aiming to provide project outcomes to study the issue and find a solution.

• To study the factors that affect patients' clinical outcomes, including structure, process, and clinical factors.
• To study the impact of the COVID-19 pandemic on the care model for elderly patients with hip fractures in fast-track surgery in hospitals and its effect on patients' clinical outcomes.
• To develop policy suggestions that will benefit from operating the policy in the care model for elderly patients with hip fractures.

Funding Source:          
Health Systems Research Institute (HSRI)

Beneficial Outcome:

• Policy suggestion that will be introduced to HAI
• Information that can be distributed to relevant personnel

Research presentation with healthcare policy suggestions for elderlies with hip fractures to

• Healthcare Accreditation Institute (HAI)
• Royal College of Orthopaedic Surgeons of Thailand
• The Royal College of Anesthesiologists of Thailand
• The Royal College of Physicians of Thailand
• The Royal College of Physiatrists of Thailand
• The Royal College of Family Physicians of Thailand
• 20 Pilot Hospitals in Thailand

Research findings and policy suggestions to develop the healthcare system and patients' well-being are as follows:

1. Hip fractures in the elderly have a high death rate per year. Surgery can drastically lower the death rate. However, nonoperative treatment is still highly prevalent in Thailand.

         Policy Suggestion: Motivation

The Ministry of Public Health should have a policy to promote the development of quality care for this patient group, through a multidisciplinary team and a follow-up system as follows:

        Motivated by Non-financial Incentives

• The Ministry of Public Health should have the Program and Disease Specific Standard (PDSS) certification.

• The Ministry of Public Health should organize a contest and awards to honor the team that provide excellent service (best practice) annually.

        Motivated by Financial Incentives

The Ministry of Public Health should establish an additional compensation system for healthcare personnel and hospitals demonstrating excellent performance.

2. Comprehensive care through a multidisciplinary team is an essential quality indicator that can lower the death rates and incidence of disability among older patients with hip fractures.

        Policy Suggestion: Develop a holistic care by multidisciplinary team

• Service plan for this patient group should include geriatricians or geriatric physicians, anesthesiologists, and rehabilitation physicians in assisting orthopedic surgeons adequately. In addition, each hospital should designate a care coordinator to oversee the patient's care from admission to discharge and return to the community.

• The Ministry of Public Health should consider establishing quality standards for the specific care from the multidisciplinary team for frail older patients.

• Relevant professional organizations e.g. the Medical Council, the Royal College, the Thailand Nursing and Midwifery Council, and others, should offer training programs for medical professionals such as physicians, nurses, physical therapists, and pharmacists, on how to care for elderly patients with hip fractures.

3. The process of effective and continuous care, along with having competent professional teams to care for patients while they are admitted to the hospital and after they return home, has the potential to promote a decrease in mortality rates, a decrease in the incidence of disability, and a decrease in the social impact of caring for elderly people with hip fractures.

        Policy Suggestion: Develop an effective and consistent care process

• The Ministry of Public Health should support a capable and sufficient interdisciplinary team to care for this population group on an ongoing basis, from acute care to intermediate care.

• Domestic research funding sources should consider funding research on key factors and procedures that promote the effective and consistent care teams.