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
Year: 2026
Type: article
Abstract: 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).
Authors: Tingzhuo Liu, Gang Liu, Ning Tang, Boya Nan, Chenguang Hao, Xuecheng Sun, Baorui Xing, Dongsheng Wu, Shuyuan Wang, Liming Li, Kangquan Shou, Yang Li, Lei Yang, Zhigang Zhong, Wei Tian, Qiang Li, Lei Si, Ronald Man Yeung Wong, Xinyi Zhang, Jing Zhang, Shangzhi Xiong, Pengpeng Ye, Rebecca Ivers, Yongchen Wang, Minghui Yang, Maoyi Tian
Institutions: Harbin Medical University, Capital Medical University, Beijing Jishuitan Hospital, Second Affiliated Hospital of Harbin Medical University, Weifang People's Hospital, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province, Weinan Central Hospital, China Three Gorges University, Yichang Central People's Hospital, Army Medical University, Daping Hospital, Wenzhou Medical University, First Affiliated Hospital of Shantou University Medical College, UNSW Sydney, The George Institute for Global Health, Anhui Medical University, Western Sydney University, Chinese University of Hong Kong, Chinese Center For Disease Control and Prevention, National Center for Chronic and Noncommunicable Disease Control and Prevention
Language: English
Topic: Hip and Femur Fractures
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,250
Award: G8101049902
OpenAlex ID: W7148583530