Factors influencing the implementation of best clinical practices for hip fracture management in resource-constrained hospitals in China and co-design of quality improvement interventions: a qualitative study
Rattachement africain : cn, au, hk. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Background: Hip fractures are a significant health issue for ageing populations, with high mortality and severe long-term effects, placing a substantial burden on healthcare systems worldwide, including in China. Although a multidisciplinary co-management model is regarded as best practice for hip fracture management, it typically involves shared care between orthopaedic teams and perioperative medical specialists such as geriatrics or internal medicine, working closely with nursing and rehabilitation staff. Its success depends on well-established medical and human resources, making implementation challenging in many settings. This study investigates the current management practices for hip fractures in county-level hospitals in China to inform development of targeted quality improvement interventions aimed at improving care. Methods: This qualitative study was conducted in three sequential steps. In the first step, focus group interviews were conducted with multidisciplinary healthcare providers and hospital administrators from ten county-level hospitals across China. Guided by national clinical guidelines, these interviews aimed to identify barriers and facilitators influencing the quality of hip fracture management in older adults. The second step employed patient journey mapping to systematically analyze the treatment and management processes for hip fractures within these hospitals. In the third step, two rounds of clinician- and manager-led, evidence-informed co-design workshops were held, bringing together clinical staff including orthopaedics, internist and general practitioners, public health professionals and health management professionals to collaboratively identify areas to be intervened and develop specific interventions. Findings: A total of ten focus group discussions were conducted, one in each province, involving 137 participants. These discussions identified ten key barriers and ten facilitators influencing the quality of hip fracture care. The patient journey mapping documented the treatment process for hip fractures in older adults across ten county-level hospitals, highlighting issues such as surgical delays and inadequate multidisciplinary collaboration. The co-design workshops led to the development of three interventions: (1) optimization of in-hospital management processes, (2) empowerment of surgeons and physicians, and (3) enhancement of awareness among patients and their families. Interpretation: This study provides a comprehensive understanding of the challenges related to the management of hip fracture in resource-constrained county-level hospitals in China. The proposed interventions are expected to improve care quality and outcomes for patients with hip fractures in resource-constrained settings. Future efforts will focus on conducting randomized controlled trials to evaluate the effectiveness of these interventions. Funding: This study was supported by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (code: ZLRK202310).
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Factors influencing the implementation of best clinical practices for hip fracture management in resource-constrained hospitals in China and co-design of quality improvement interventions: a qualitative study
- Date Crossref
- 01/04/2026
- Éditeur
- Elsevier BV
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Harbin Medical University Department of Orthopaedics pays non établi dans la noticeUniversité ou école supérieure
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Capital Medical University Department of Orthopaedics and Traumatology pays non établi dans la noticeUniversité ou école supérieure
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Peking University pays non établi dans la noticeUniversité ou école supérieure
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Beijing Jishuitan Hospital pays non établi dans la noticeÉtablissement de santé
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Second Affiliated Hospital of Harbin Medical University pays non établi dans la noticeÉtablissement de santé
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Weifang Medical University pays non établi dans la noticeUniversité ou école supérieure
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Weifang People's Hospital pays non établi dans la noticeÉtablissement de santé
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Cangzhou Central Hospital pays non établi dans la noticeÉtablissement de santé
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People's Hospital of Cangzhou pays non établi dans la noticeÉtablissement de santé
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Weinan Central Hospital Department of Trauma Orthopaedics pays non établi dans la noticeÉtablissement de santé
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Anyang Hospital of Traditional Chinese Medicine pays non établi dans la noticeÉtablissement de santé
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Changzhi Medical College pays non établi dans la noticeUniversité ou école supérieure
Department of Orthopaedics — Harbin Medical University, Department of Orthopaedics and Traumatology — Capital Medical University et Peking University, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.