Objectives;​ The primary objectives of this project were to determine how the use of a caremap for treatment of elderly hip fracture patients affected functional recovery, institutionalization and health-related quality of life in the first six-months following hip fracture. Secondary objectives were to examine differences in morbidity, in-hospital mortality and health service utilization before and after caremap implementation. Finally, tertiary objectives were to determine if care delivery differed before and after the caremap was introduced.

Methods:​ Two population-based inception cohorts of hip fracture patients 65 years and older, the first group (n=468) enrolled between July 1996 and September 1997 prior to caremap implementation and the second group (n=451) enrolled between July 1999 and September 2000 following implementation of standardized care, were used to meet study objectives. Subjects completed standardized questionnaires examining function and health-related quality of life while in hospital and then at follow-up telephone interviews three and six-months postoperatively. Institutionalization rates were obtained during follow-up interviews by determining patients’ residence at time of interview. To meet the secondary and tertiary study objectives, chart reviews were completed on all eligible subjects who sustained a hip fracture during the study time periods to determine complications, mortality and service delivery outcomes.

Results:​ Functional recovery was improved at three months postoperatively in subjects with poor social contact in the post caremap cohort after adjusting for confounders. Risk-adjusted institutionalization was also reduced in this same patient group. Health-related quality of life was not different between cohorts. Morbidity as measured by postoperative complications and intensive care unit admissions was significantly reduced in the Caremap cohort, but there was no difference in risk-adjusted in-hospital mortality between groups. Care delivery was improved in the Caremap cohort with less variation in practice in terms of timing of interventions and medication profiles.

Conclusion:​ Overall, using a caremap during the perioperative period did not affect function, health-related quality of life or institutionalization in elderly hip fracture patients. However, function was improved and institutionalization reduced in patients with poor social contacts in the Caremap cohort. Morbidity was also reduced in the Caremap compared to the Control cohort.