Adoption of hip fracture care standards: a mixed-methods analysis of patient and healthcare provider perspectives

Objectives: To evaluate the implementation of the Australian Hip Fracture Clinical Care Standard for patients with low-trauma hip fracture. This study aimed to (1) document facility-level adoption, (2) explore healthcare providers' perspectives on Standard delivery and (3) describe patient engagement with post-acute discharge care recommendations, including outcomes for culturally and linguistically diverse (CALD) and limited English proficiency subgroups. Methods: A mixed-methods approach was undertaken. Community-dwelling adults who underwent surgical treatment for low-trauma hip fractures at a tertiary hospital over 1 year were included. Facility-level adoption was determined by auditing medical records against the Clinical Care Standard. Patient engagement with post-discharge recommendations was assessed by structured telephone follow-up at 16 weeks and English proficiency. An electronic survey explored healthcare providers' perspectives of Standard implementation. Results: Of 189 patients admitted, 136 (72%) were eligible; 127 completed follow-up assessment. The cohort was predominantly female (66%), with a mean age of 79 years and 80% migrants. Most components of the Care Standard were implemented with high fidelity (> 90% for four of seven indicators). Acute care data indicated effective implementation of most components of the Care Standard, supported by responses from 28 healthcare providers (28% response rate). However, healthcare providers highlighted the need for enhanced interprofessional training and resourcing for refracture prevention. Patient engagement with refracture prevention recommendations was low (44% participated in strength exercises, 26% in balance, 11% sought dietary advice and 44% consumed calcium supplementation), with no significant differences by CALD status or English proficiency. Conclusions: Despite high facility-level implementation of the Care Standard, patient adoption of post-discharge refracture prevention strategies remains suboptimal. Bridging this gap requires multi-faceted, consumer-centred solutions and improved interdisciplinary training to enhance outcomes and reduce refracture risk, particularly in diverse and multicultural populations.