NP-CRO-1158-065-066-GB-GOV-10-RIGHT-4-203194 Kathmandu Medical College Public Limited The primary objective is to improve health-related quality of life for patients following hip fracture and to reduce healthcare costs in LMIC. The aim is to deliver a cluster randomised trial of the HIPCARE intervention with embedded process and economic evaluations. Within the cluster RCT, the following objectives will be assessed for the entire study population and each LMIC individually: i. To compare Health-Related Quality of Life between the treatment groups at 120 days post-surgery ii. To compare mortality between the treatment groups within the first 120 days post-surgery. iii. To compare mobility between the treatment groups at 120 days post-surgery. iv. To compare the proportion of participants returning to their pre-fracture residential status by 120 days post-surgery between the treatment groups. v. To compare the complication rate between the treatment groups within the first 120 days post-surgery. vi. To compare the healthcare and broader resource implications for both treatment groups up to 120 days post-surgery vii. To estimate the comparative cost-effectiveness of the treatments up to 120 days post-surgery. In addition, this study will consolidate a research collaboration and sustainable infrastructure that can be used to facilitate future service improvement in each LMIC. Study Participants: Patients aged 60 years or over having surgery for a hip fracture. Inclusion Criteria: Patients aged 60 years or over, having surgery for a hip fracture. The participant may not enter the study if they or a carer are unlikely to be available for follow-up at 120 days, e.g. foreign national returning to another country. The eligibility criteria have been kept as broad as possible to ensure that the cohort of patients can be generalised as widely as possible to the background population with hip fractures. Throughout the study, screening logs will be kept to determine the number of patients assessed for eligibility and reasons for any exclusion. Older patients are particularly likely to break a bone (fracture) because of a fall from a standing height, as their bones are weakened by osteoporosis. These fragility fractures have serious consequences; in the UK 25% of hip fracture patients die within a year and survivors have a reduction in their quality-of-life similar to having a stroke. Outcomes may be even worse in LMIC without the same level of healthcare resource. Asia is particularly affected by rapidly ageing populations. The number of hip fractures is expected to increase from 1,124,060 now to 2,563,488 in 2050. Associated healthcare cost may rise to US$15 billion. Improving care for patients with hip fracture is therefore a priority in this region. Looking after patients following a hip fracture requires healthcare workers from many different backgrounds to work together. These include surgeons, doctors specialising in looking after older patients, nurses and therapists, each with defined roles and responsibilities. In the UK, this team approach has reduced the number of patients dying and improved quality-of-life after hip fracture. It also reduced time spent in hospital and associated healthcare costs. Our project has two parts: 1. To refine the multidisciplinary HIPCARE training and support package for each LMIC. 2. To see if the HIPCARE intervention improves the quality-of-life for hip fracture patients in LMIC and whether it reduces healthcare costs, compared with usual care. The HIPCARE training package has three main components: early surgery to fix the hip fracture, early assessment by a medical doctor and early walking with the help of a therapist to speed recovery. The HIPCARE training package has three main components: early surgery to fix the hip fracture, early assessment by a medical doctor and early walking with the help of a therapist to speed recovery. Having refined the training materials to make HIPCARE specific to each country, we will do a large study to compare HIPCARE with usual care in 40 hospitals in LMIC. Community engagement and involvement: This proposal has been developed together with members of the Global Health Fragility Fractures Community Engagement and Involvement Panel with support from the World Musculoskeletal Trauma Patient and Public Involvement Group. The views of patients and their carers, from Asia and the UK, informed all aspects of the study but in particular the choice of eligibility criteria, primary outcome measure and follow-up plan. Dissemination: We disseminate the findings of this study: 1. Through plain language summaries specific to each country via social media/web-pages as well as hard-copy 2. Through our partnership with the Global Fragility Fracture Network, with its many events worldwide 3. Through scientific publications and presentations. The University of Oxford The University of Oxford Kathmandu Medical College Public Limited University of Philippines Manila Mahidol University, Faculty of Medicine Ramathibodi Hospital The Hanoi University of Public Health George Institute Services India Private Limited All India Institute of Medical Sciences, New Delhi University of New South Wales UK - Department of Health and Social Care (DHSC) Actual start date of NIHR grant NIHR203194. Planned end date of NIHR grant NIHR203194. https://hipcare.ndorms.ox.ac.uk hipcare@ndorms.ox.ac.uk