Closing the Gap in Hip Fracture Care
A small SPHERE seed grant has transformed the way older people recovering from hip fracture are supported after leaving hospital, embedding a new model of care that is now a routine part of service delivery at Liverpool Hospital.
Funded through the SPHERE Implementation Science Strategic Platform's 2022 Translational Seed Funding Scheme, the project addressed a critical gap in hip fracture care. While acute hospital treatment generally aligned with national standards, many patients were missing out on the ongoing support needed to strengthen bone health, prevent future fractures and maximise their recovery after discharge.
From 2023–24, a multidisciplinary team led by Dr Carlos El Haddad, A/Professor Danielle Ni Chroinin and Professor Justine Naylor, brought together researchers and clinicians across the Musculoskeletal, Implementation Science and Age and Ageing Clinical Themes to establish a post-discharge Hip Fracture Clinic. The implementation evaluation was led by Bernadette (Bernie) Brady from South Western Sydney Local Health District (SWSLHD).
“SPHERE funding gave us the opportunity to take an evidence-based model and see whether it could work in routine clinical practice,” Bernie said.
“The project demonstrated that coordinated follow-up after hospital discharge can make a real difference for patients while also identifying where our health system can improve.”
Over the two-year project, the team successfully implemented and evaluated a six-week Hip Fracture Clinic at Liverpool Hospital. The clinic provides structured follow-up care focused on fracture healing, bone health assessment and preventing future fractures. Importantly, it has now become an ongoing component of routine service delivery within the district.
High patient approval
Patients, particularly those from culturally and linguistically diverse communities, reported that the coordinated approach gave them greater confidence during recovery by providing clearer information, improved communication and easier access to services. The clinic also addressed important gaps in continuity of care that had previously limited opportunities for secondary fracture prevention.
The project also revealed valuable insights into where further improvements are needed.
Although hospitals were largely meeting acute-care standards, the mixed-methods study found much lower uptake of recommended prevention strategies once patients returned home. Less than half of participants were performing strengthening exercises, very few had consulted a dietitian, and many were not engaging with recommended bone health and falls prevention strategies. Healthcare providers also identified the need for better interdisciplinary training, clearer referral pathways and improved access to outpatient services for vulnerable communities.
Rather than simply identifying these gaps, the project provided a roadmap for addressing them.
Improving systems and rehabilitation
The findings directly informed new translational initiatives across South Western Sydney, including the development of a hip fracture-specific discharge summary, led by Dr Thuy Bui, to improve communication with general practitioners and the creation of innovative rehabilitation models, HITH4HIPS and RITH4HIPS, led by Professor Justine Naylor, to improve recovery while reducing transport barriers and hospital length of stay.
The project has also strengthened the evidence base for improving hip fracture care nationally. Findings have been published in peer-reviewed journals, presented at the World Confederation of Physiotherapy Congress in Japan, and featured as an invited presentation at the Australian and New Zealand Hip Fracture Registry HipFest Conference. The research has also reached broader clinical and public audiences through an Oxford University Press blog article, Why recovery after a hip fracture is about more than bones, which highlighted the importance of understanding recovery in the context of culture, family, beliefs and everyday life.
Bernie said one of the project's greatest achievements was demonstrating how implementation research can bridge the gap between evidence and everyday clinical practice.
“Generating evidence is only part of the solution. We also need to understand how to implement that evidence in ways that work for patients, clinicians and health services. SPHERE's support enabled us to do exactly that.”
Although modest in scale, the project has left a lasting legacy. By embedding a sustainable model of post-discharge care and identifying practical ways to improve recovery and fracture prevention, the Hip Fracture Care Project is helping ensure more older Australians receive the coordinated care they need to remain healthy, independent and active after a life-changing injury.