Co-creation of a person-centred integrated digital health model of care for fragility hip fractures: a mixed methods pragmatic research

Abstract

Hip fracture is among the most devastating events faced by older people. These fragility fractures often occur due to trivial or low trauma falls. Current treatment efforts have led to best practice management guidelines and clinical audits at the level of the acute hospital setting and, to a certain extent, immediate post-hospital discharge. However, concerns still exist in the areas of prevention and rehabilitation outcomes including quality of life, and functional independence. Based on emerging evidence, a more nuanced approach is required for future health services delivery which incorporates: 1) musculoskeletal health; 2) increasing burden of multimorbidities; and 3) societal influences and circumstances shaping individual’s health literacy including access to digital technology. The aim of this thesis work is to conduct a program of research focused on establishing a personcentred and integrated model of care for older people with hip fractures assisted by digital health technology and modern educational approaches. The goal is to improve outcomes such as health literacy, access, functional rehabilitation, and quality of life. Objectives 1. To map out digital health interventions by conducting a comprehensive systematic review, which evaluates the effectiveness of digital health supported targeted patient communication versus usual provision of health information, on the recovery from fragility fractures. 2. To determine different phases of a research program for the development of a digital health hub enabled model of care focused on hip fracture rehabilitation through a dynamic conceptual framework. 3. To understand the perspective of older people with hip fractures, their family members, and residential aged carers, to inform the development of a personalised digital health hub and factors impacting the likelihood of potential usage. 4. To understand the perspectives of clinicians from various medical and surgical disciplines, allied health, and other relevant non-health stakeholders to inform the development of a digital health enabled model of care for fragility fractures. 5. To examine the process and management of innovation, and the strategic directions required to improve musculoskeletal healthcare at macro (policy), meso (service delivery), and micro (clinical practice) levels and discuss the critical role of different stakeholders in driving innovations in healthcare. 6. To describe a vision for future health care to address increasing population multimorbidity through the co-creation of personalised digital health hubs that recognise the importance of patient agency in driving the evolution of health services. This study emphasises that digital health solutions must be co-created and co-implemented by engaging relevant stakeholders including end consumers at the local contextual level. Developed countries such as Australia are emerging global leaders in contemporary research focused on advancing knowledge and filling gaps within existing health service delivery for older people.