The Outcome and Cost Analysis of Home-care Physical Therapy for Postoperative Hip Fracture Patients

The aims of this study are: 1. To develop a disease-specific questionnaire for hip fractures. 2. To find the influences of physical therapy (PT) on patients\' function and health-related quality of life (HRQL). 3. To estimate the quality adjusted life years (QALY) of cases of hip fracture with or without the PT program by a quality-adjusted survival (QAS) method. 4. To perform cost effectiveness analysis (CEA) to evaluate the effectiveness of PT and as a base to compare it with other health intervention programs. At the beginning of the study, the investigators will develop the disease-specific questionnaire for hip fractures. Cases of patients with hip fractures hospitalized in orthopedic wards of the National Taiwan University Hospital (NTUH) and Chung-Hsing Hospital of Taipei from August 1, 1989 to July 31, 1999 are the study population during the first year of this study. According to their receiving PT or not during hospitalization, the patients are assigned to a PT or non-PT group. The identification (ID) numbers will be matched with the death certificate file of the Department of Health to verify the survival status. Furthermore, 30 cases per group per year will be randomly sampled to interview their HRQL and evaluate their function with the disease-specific questionnaire for hip fractures. Combining the survival function and HRQL, the QALY could be estimated. Cases of hip fracture admitted to the orthopedic ward of NTUH and receiving a PT program from January 1, 2000 will be the second-year study population in this study. They will be randomly assigned to a group of follow-up PT (group I) or non-follow-up PT (group II). The patients assigned to group I will have a 4-time PT evaluation and treatment at home after discharge from the hospital (1 week, 1 month, 3 months and 6 months after discharge). All patients will be evaluated at discharge, 1 month, 6 months, and 1 year after discharge to follow their survival status, functional status and HRQL. The expected results of this study will be to develop the disease-specific questionnaire for hip fractures, to show the functional outcomes of cases of hip fracture, and to estimate the QALY of them.