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Objectives: To develop a transmural pathway for healthcare professionals across institutions to monitor the recovery of hip fracture patients. The secondary objectives were to evaluate the pathway's feasibility and initial outcomes. Design: Prospective cohort study. Method: Stakeholders of the hospital and geriatric rehabilitation institutions implemented a transmural monitoring pathway in which different geriatric health domains were monitored during three phases: The in-hospital, inpatient rehabilitation, and outpatient follow-up phase. The outcomes for the first 291 patients and the feasibility of the pathway were evaluated. If the outcomes of the clinimetrics significantly improved over time, progress in functional recovery was assumed. Feasibility was assessed according to the rate of adherence to the clinimetric tests. Results: During the in-hospital phase, patients showed a decline in functional level (the Katz index of independence in Activities of Daily Living (Katz-ADL) pre-fracture vs. discharge: 0 (0–2) vs. 4 (4–5), P < 0.001). Patients, in which 78.6% (n = 140) had cognitive impairment and 41.2% had malnutrition, showed the most progress (Katz-ADL 2 (1–3)) during the inpatient rehabilitation phase. In the outpatient follow-up phase, recovery remained ongoing, but most patients had not returned to their pre-fracture functional levels (Katz-ADL 1 (1–3)). The pathway feasibility during the first phase was excellent (>85%), whereas room for improvement existed during other phases (<85%). Conclusion: The transmural monitoring pathway provides insight into the entire recovery process for all involved healthcare professionals. Patients showed the most progress during the rehabilitation phase. The pathway feasibility was excellent during the in-hospital phase, but improvements could be made during other phases. [ABSTRACT FROM AUTHOR]

Integrated orthogeriatric treatment, led by a nurse practitioner, is an important step forward in the improvement of care for older people with a hip fracture. In this paper we reflect on the study of Van Leendert et al. Their main findings are similar to the literature with a significantly reduced 1-year mortality rate in the orthogeriatric group compared to the standard care group. However, there are some remarks to be made regarding the patient characteristics that are unbalanced in favor of the orthogeriatric group, with an overrepresentation of a certain type of fracture, indicating potentially more vulnerable patients in the standard care group. Although a significant step forward, we also address that still face major challenges, that technology might be an enabler for further improvement but that it might also be time to introduce a new perspective on recovery that makes better use of the dynamics of the system.