<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT02212353</url>
  </required_header>
  <id_info>
    <org_study_id>DTC-RP-PG-0311-12004</org_study_id>
    <nct_id>NCT02212353</nct_id>
  </id_info>
  <brief_title>Care Delivery in Acute Hospital Settings: an Observational Study</brief_title>
  <acronym>PERFECTED</acronym>
  <official_title>Care Delivery in Acute Hospital Settings: an Observational Study. WP1 P3</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>University of East Anglia</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>University of East Anglia</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
  </oversight_info>
  <brief_summary>
    <textblock>
      This small observational study is a contractual component of a 5-year (2013-18) NIHR funded&#xD;
      programme called PERFECTED (Peri-operative Enhanced Recovery hip FracturE Care of paTiEnts&#xD;
      with Dementia) whose overall aim is to develop and pilot an evidence-based intervention to&#xD;
      improve the hospital care of patients with dementia suffering a fractured hip. The findings&#xD;
      from this particular observational study will support other PERFECTED work-packages in&#xD;
      establishing current care practices in acute hospital settings for older people in general&#xD;
      with hip fractures.&#xD;
&#xD;
      Observation is a well-established qualitative technique widely used to understand cultures,&#xD;
      processes and interactions in defined locations including hospitals. In this study,&#xD;
      researchers will observe day-to-day practices on specific ortho-geriatric wards and Emergency&#xD;
      Departments in three English hospitals (Norfolk and Norwich University Hospital, Bradford&#xD;
      Royal Infirmary and Queen's Medical Centre in Nottingham). Observations will occur&#xD;
      intermittently over a 4-week period, covering the full 24h cycle. The prime objective of the&#xD;
      study is to describe delivery of care to older patients with a hip fracture including an&#xD;
      assessment of cost consequences. Crucially, the observations will focus exclusively upon the&#xD;
      hospital personnel that routinely provide care in the designated locations being observed.&#xD;
      Other individuals who frequent the locations (patients, visitors and other more peripheral&#xD;
      health care professionals) are NOT the focus of the research and will be regarded as&#xD;
      &quot;incidental others&quot; rather than &quot;participants&quot;. This approach is common in observational&#xD;
      research.&#xD;
&#xD;
      Observations will be conducted by experienced qualitative researchers and assisted by&#xD;
      specifically trained lay researchers to provide a valuable service-user dimension to the&#xD;
      study. Field-notes and contextual information will be collected and thematically analysed,&#xD;
      again in partnership with trained 'lay' researchers. Resulting data will address the&#xD;
      pre-defined aims of the observational study and feed into the findings reported across the&#xD;
      whole of work package 1 of PERFECTED.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Rationale and background information&#xD;
&#xD;
      Hip fracture&#xD;
&#xD;
      Hip fracture is a common orthopaedic injury amongst older adults. It is estimated that more&#xD;
      than 1.2 million individuals will suffer hip fracture annually worldwide (Gullberg et al,&#xD;
      1997) and this total is expected to surpass 6 million by the year 2050 (Cooper et al, 1992;&#xD;
      Odén et al, 2013). Hip fracture has a significant impact on the health and independence of&#xD;
      patients and their families, with an increased risk of functional decline, admission to&#xD;
      long-term care institutions and high mortality rates within the first 12 months post-fracture&#xD;
      (Seitz et al, 2011). Furthermore the economic implications for the NHS are significant in&#xD;
      both direct and indirect costs (Hernlund et al, 2013).&#xD;
&#xD;
      People with dementia&#xD;
&#xD;
      It is estimated that 25% of all beds in UK acute hospital wards are occupied by people with&#xD;
      dementia (PwD) (Royal College of Psychiatrists 2009). Improving acute hospital care for PwD&#xD;
      is high on the national agenda, as this group is particularly vulnerable to poor quality care&#xD;
      and adverse outcomes (NHS Confederation 2010). Patients with dementia - primarily older&#xD;
      people, are highly susceptible to insensitive care as complex needs in relation to their&#xD;
      memory, thinking, orientation, comprehension, calculation, learning capability, language, and&#xD;
      judgment are often unrecognised and unaddressed (Alzheimer Society 2009). Older people and&#xD;
      their families consistently place high value on hospital care which promotes personalised&#xD;
      relationships between patients and staff. This is particularly pertinent for people with&#xD;
      impaired cognition or communication difficulties ( Alzheimer Society 2009).&#xD;
&#xD;
      People with hip fracture and dementia&#xD;
&#xD;
      People with dementia (PwD) have a four-fold increased risk of a hip fracture compared to&#xD;
      matched cognitively intact cohorts (Gruneir et al, 2010; Laditka et al, 2005). Identifying&#xD;
      the needs of people with dementia can be difficult. Engagement and progress with&#xD;
      post-operative hip fracture rehabilitation can also be compromised for patients with&#xD;
      dementia. Data suggests that clinical outcomes (incidence of delirium, mortality and&#xD;
      post-operative complication rates) are poorer for PwD following hip fracture when compared to&#xD;
      cognitively intact individuals (Smith et al, 2013).&#xD;
&#xD;
      Enhanced Recovery Pathways&#xD;
&#xD;
      The process of &quot;Enhanced Recovery&quot; was developed in Denmark by Prof Kehlet and has been used&#xD;
      in the UK since the early 2000s (Department of Health 2013a). It is an integrated,&#xD;
      multi-modal, evidence-based approach that enables hospital patients to recover from surgery,&#xD;
      treatment or illness more effectively and leave hospital sooner. Since their formal&#xD;
      introduction into the NHS in 2009, Enhanced Recovery Pathways (ERP) are becoming standard&#xD;
      practice for many elective surgical operations and have resulted in a reduction in both&#xD;
      length of hospital stays and readmission rates while generating high levels of patient&#xD;
      satisfaction (Department of Health 2013a).&#xD;
&#xD;
      Enhanced Recovery Pathways (ERP) for elective surgery are becoming more common and there is&#xD;
      an increasing commitment to drive the delivery of enhanced recovery as standard practice&#xD;
      (Department of Health 2013a). ERP in acute hip fracture is much rarer. The pathways are&#xD;
      typically structured around six discrete phases which follows the patients' journal from&#xD;
      hospital arrival through to discharge, these are:&#xD;
&#xD;
        -  Emergency Department - arrival and diagnoses&#xD;
&#xD;
        -  Pre-operative - ward admittance and preparation for operation&#xD;
&#xD;
        -  Intra-operative - the operation&#xD;
&#xD;
        -  Post-operative - recovery from the operation&#xD;
&#xD;
        -  Rehabilitation - optimising recovery of function&#xD;
&#xD;
        -  Discharge - return to home or appropriate residence&#xD;
&#xD;
      These pathways are based upon evidence-based, documented national and internationally expert&#xD;
      guidelines and are subject to frequent clinical review. A key co-morbidity that is recognised&#xD;
      is cognitive impairment and as described above clinical outcomes for PwD can be significantly&#xD;
      worse to non-cognitively impaired patients. Following National Guidelines on Dementia Care&#xD;
      (Department of Health 2009a) most acute hospital Trusts are implementing general dementia&#xD;
      care strategies throughout hospitals. Given that the proportion of patients dementia that&#xD;
      sustain hip fractures is increasing year on year, some experts (McGilton et al 2013) have&#xD;
      suggested that the subgroup of patients with dementia and hip fracture should have a specific&#xD;
      treatment pathway, to acknowledge the clear differences in presentation and care needs.&#xD;
      Developing an ERP specifically for patients with dementia and hip-fracture is the precise&#xD;
      objective of the overall PERFECTED research programme.&#xD;
&#xD;
      The PERFECTED research programme&#xD;
&#xD;
      The PERFECTED (Peri-operative Enhanced Recovery hip FracturE Care of paTiEnts with Dementia)&#xD;
      research programme was awarded to Dr Chris Fox (UEA) in November 2013. This is a 5 year&#xD;
      project funded under the National Institute for Health Research (NIHR) Programme Grant for&#xD;
      Applied Research initiative. For a summary of the accepted research proposal please see annex&#xD;
      1. The overall aim of PERFECTED is to improve hospital care for PwD admitted with a fractured&#xD;
      hip. The research will first develop and then examine the feasibility, acceptability and&#xD;
      potential clinical and cost effectiveness of an optimised &quot;enhanced recovery pathway&quot; (ERP)&#xD;
      for these patients. The PERFECTED programme is structured as 4 Work Packages (WPs); the&#xD;
      primary aims of each are as follows:&#xD;
&#xD;
        -  WP1: to establish best practice and define an ERP for patients with hip fracture and&#xD;
           dementia in acute hospitals.&#xD;
&#xD;
        -  WP2: to determine the staff training and cultural/organisational changes required to&#xD;
           implement and maximise adherence to the aforementioned ERP.&#xD;
&#xD;
        -  WP3: to undertake a pilot study to assess the clinical and cost effectiveness of the ERP&#xD;
           that will inform the design of a future definitive Randomised Controlled Trial.&#xD;
&#xD;
        -  WP4: to disseminate the data and lessons learned from the programme and develop a&#xD;
           definitive trial proposal.&#xD;
&#xD;
      This protocol relates to phase 3 of WP1 only. This specific phase is an observational study&#xD;
      and involves researchers observing care delivery in specified ortho-geriatric wards at the&#xD;
      Norfolk and Norwich University Hospital (NNUH), the Queen's Medical Centre (QMC) Nottingham&#xD;
      and the Bradford Royal Infirmary (BRI). Observations will also take place in the Emergency&#xD;
      Department (ED) of each of these hospitals on an opportunistic basis. Observations will occur&#xD;
      in each of the sites intermittently over a 4-week period sequentially and will cover the full&#xD;
      24h cycle. That is, we will do 4 weeks of observations at the NNUH, before moving to BRI and&#xD;
      observing for 4 weeks, and then finish by undertaking 4 weeks of observations at QMC. Data&#xD;
      elicited from these observations will address this study's research aims and will also inform&#xD;
      the wider aims of WP1 by describing the context (including cost consequences) of care&#xD;
      delivery to hospital patients with hip fracture, some of whom will have dementia. It is&#xD;
      essential to emphasise that although PERFECTED overall (including WP1) is concerned with&#xD;
      older hip-fracture patients who have dementia, phase 3 WP1 (this observational study) is&#xD;
      concerned with all older hip-fracture patients in general.&#xD;
&#xD;
      As a research programme PERFECTED is iterative. To create one total ethical protocol would&#xD;
      not be feasible. We will be submitting numerous protocols in line with the programme's&#xD;
      development. The aims, procedures and ethical considerations associated with phase 3 WP1, the&#xD;
      observational study, are the sole objectives of this protocol.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">September 1, 2014</start_date>
  <completion_date type="Actual">December 16, 2014</completion_date>
  <primary_completion_date type="Actual">December 12, 2014</primary_completion_date>
  <study_type>Observational</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <observational_model>Cohort</observational_model>
    <time_perspective>Prospective</time_perspective>
  </study_design_info>
  <primary_outcome>
    <measure>To observe and describe the general day-to-day practices and routines in three English acute hospitals for treating older patients with hip fracture.</measure>
    <time_frame>Observations in each of the 3 sites will take place for a 4 week period.</time_frame>
    <description>The overall aim of this study (phase 3, WP1 of PERFECTED) is to observe and describe the general day-to-day practices and routines in three English acute hospitals for treating older patients with hip fracture. The influence on care practices of significant co-morbidities, particularly dementia, will especially be noted. Observations will take place in defined areas on specified ortho-geriatric wards and in EDs. The study's aims and objectives focus on the delivery of care. As such, the focus of the observations is solely upon those health professionals who routinely deliver care in the designated spaces.</description>
  </primary_outcome>
  <number_of_groups>3</number_of_groups>
  <enrollment type="Actual">180</enrollment>
  <condition>Dementia</condition>
  <condition>Hip Fractures</condition>
  <arm_group>
    <arm_group_label>Site 1 Health Care Professionals</arm_group_label>
    <description>Observational research. This is a cohort of health care professionals working in site 1 in delivering to care to neck of femur patients.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Site 2 Health Care Professionals</arm_group_label>
    <description>Observational research. This is a cohort of health care professionals working in site 2 in delivering to care to neck of femur patients.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Site 3 Health Care Professionals</arm_group_label>
    <description>Observational research. This is a cohort of health care professionals working in site 3 in delivering to care to neck of femur patients.</description>
  </arm_group>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Observational study, not interventional</intervention_name>
    <arm_group_label>Site 1 Health Care Professionals</arm_group_label>
    <arm_group_label>Site 2 Health Care Professionals</arm_group_label>
    <arm_group_label>Site 3 Health Care Professionals</arm_group_label>
  </intervention>
  <eligibility>
    <study_pop>
      <textblock>
        Secondry Care&#xD;
      </textblock>
    </study_pop>
    <sampling_method>Non-Probability Sample</sampling_method>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Health Care Professioanls delivering care in the observational environments&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Those who are not Health Care Professioanls delivering care in the observational&#xD;
             environments&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>N/A</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>George C Fox</last_name>
    <role>Principal Investigator</role>
    <affiliation>University of East Anglia</affiliation>
  </overall_official>
  <link>
    <url>http://www.perfected.ac.uk</url>
    <description>PERFECTED Programme homepage</description>
  </link>
  <verification_date>August 2017</verification_date>
  <study_first_submitted>August 6, 2014</study_first_submitted>
  <study_first_submitted_qc>August 7, 2014</study_first_submitted_qc>
  <study_first_posted type="Estimate">August 8, 2014</study_first_posted>
  <last_update_submitted>August 9, 2017</last_update_submitted>
  <last_update_submitted_qc>August 9, 2017</last_update_submitted_qc>
  <last_update_posted type="Actual">August 11, 2017</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Hip Fractures</mesh_term>
  </condition_browse>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT02212353
org study id: DTC-RP-PG-0311-12004
nct id: NCT02212353
lead sponsor: 
has dmc: Yes
This small observational study is a contractual component of a 5-year (2013-18) NIHR funded
      programme called PERFECTED (Peri-operative Enhanced Recovery hip FracturE Care of paTiEnts
      with Dementia) whose overall aim is to develop and pilot an evidence-based intervention to
      improve the hospital care of patients with dementia suffering a fractured hip. The findings
      from this particular observational study will support other PERFECTED work-packages in
      establishing current care practices in acute hospital settings for older people in general
      with hip fractures.

      Observation is a well-established qualitative technique widely used to understand cultures,
      processes and interactions in defined locations including hospitals. In this study,
      researchers will observe day-to-day practices on specific ortho-geriatric wards and Emergency
      Departments in three English hospitals (Norfolk and Norwich University Hospital, Bradford
      Royal Infirmary and Queen's Medical Centre in Nottingham). Observations will occur
      intermittently over a 4-week period, covering the full 24h cycle. The prime objective of the
      study is to describe delivery of care to older patients with a hip fracture including an
      assessment of cost consequences. Crucially, the observations will focus exclusively upon the
      hospital personnel that routinely provide care in the designated locations being observed.
      Other individuals who frequent the locations (patients, visitors and other more peripheral
      health care professionals) are NOT the focus of the research and will be regarded as
      "incidental others" rather than "participants". This approach is common in observational
      research.

      Observations will be conducted by experienced qualitative researchers and assisted by
      specifically trained lay researchers to provide a valuable service-user dimension to the
      study. Field-notes and contextual information will be collected and thematically analysed,
      again in partnership with trained 'lay' researchers. Resulting data will address the
      pre-defined aims of the observational study and feed into the findings reported across the
      whole of work package 1 of PERFECTED.
Rationale and background information

      Hip fracture

      Hip fracture is a common orthopaedic injury amongst older adults. It is estimated that more
      than 1.2 million individuals will suffer hip fracture annually worldwide (Gullberg et al,
      1997) and this total is expected to surpass 6 million by the year 2050 (Cooper et al, 1992;
      Odén et al, 2013). Hip fracture has a significant impact on the health and independence of
      patients and their families, with an increased risk of functional decline, admission to
      long-term care institutions and high mortality rates within the first 12 months post-fracture
      (Seitz et al, 2011). Furthermore the economic implications for the NHS are significant in
      both direct and indirect costs (Hernlund et al, 2013).

      People with dementia

      It is estimated that 25% of all beds in UK acute hospital wards are occupied by people with
      dementia (PwD) (Royal College of Psychiatrists 2009). Improving acute hospital care for PwD
      is high on the national agenda, as this group is particularly vulnerable to poor quality care
      and adverse outcomes (NHS Confederation 2010). Patients with dementia - primarily older
      people, are highly susceptible to insensitive care as complex needs in relation to their
      memory, thinking, orientation, comprehension, calculation, learning capability, language, and
      judgment are often unrecognised and unaddressed (Alzheimer Society 2009). Older people and
      their families consistently place high value on hospital care which promotes personalised
      relationships between patients and staff. This is particularly pertinent for people with
      impaired cognition or communication difficulties ( Alzheimer Society 2009).

      People with hip fracture and dementia

      People with dementia (PwD) have a four-fold increased risk of a hip fracture compared to
      matched cognitively intact cohorts (Gruneir et al, 2010; Laditka et al, 2005). Identifying
      the needs of people with dementia can be difficult. Engagement and progress with
      post-operative hip fracture rehabilitation can also be compromised for patients with
      dementia. Data suggests that clinical outcomes (incidence of delirium, mortality and
      post-operative complication rates) are poorer for PwD following hip fracture when compared to
      cognitively intact individuals (Smith et al, 2013).

      Enhanced Recovery Pathways

      The process of "Enhanced Recovery" was developed in Denmark by Prof Kehlet and has been used
      in the UK since the early 2000s (Department of Health 2013a). It is an integrated,
      multi-modal, evidence-based approach that enables hospital patients to recover from surgery,
      treatment or illness more effectively and leave hospital sooner. Since their formal
      introduction into the NHS in 2009, Enhanced Recovery Pathways (ERP) are becoming standard
      practice for many elective surgical operations and have resulted in a reduction in both
      length of hospital stays and readmission rates while generating high levels of patient
      satisfaction (Department of Health 2013a).

      Enhanced Recovery Pathways (ERP) for elective surgery are becoming more common and there is
      an increasing commitment to drive the delivery of enhanced recovery as standard practice
      (Department of Health 2013a). ERP in acute hip fracture is much rarer. The pathways are
      typically structured around six discrete phases which follows the patients' journal from
      hospital arrival through to discharge, these are:

        -  Emergency Department - arrival and diagnoses

        -  Pre-operative - ward admittance and preparation for operation

        -  Intra-operative - the operation

        -  Post-operative - recovery from the operation

        -  Rehabilitation - optimising recovery of function

        -  Discharge - return to home or appropriate residence

      These pathways are based upon evidence-based, documented national and internationally expert
      guidelines and are subject to frequent clinical review. A key co-morbidity that is recognised
      is cognitive impairment and as described above clinical outcomes for PwD can be significantly
      worse to non-cognitively impaired patients. Following National Guidelines on Dementia Care
      (Department of Health 2009a) most acute hospital Trusts are implementing general dementia
      care strategies throughout hospitals. Given that the proportion of patients dementia that
      sustain hip fractures is increasing year on year, some experts (McGilton et al 2013) have
      suggested that the subgroup of patients with dementia and hip fracture should have a specific
      treatment pathway, to acknowledge the clear differences in presentation and care needs.
      Developing an ERP specifically for patients with dementia and hip-fracture is the precise
      objective of the overall PERFECTED research programme.

      The PERFECTED research programme

      The PERFECTED (Peri-operative Enhanced Recovery hip FracturE Care of paTiEnts with Dementia)
      research programme was awarded to Dr Chris Fox (UEA) in November 2013. This is a 5 year
      project funded under the National Institute for Health Research (NIHR) Programme Grant for
      Applied Research initiative. For a summary of the accepted research proposal please see annex
      1. The overall aim of PERFECTED is to improve hospital care for PwD admitted with a fractured
      hip. The research will first develop and then examine the feasibility, acceptability and
      potential clinical and cost effectiveness of an optimised "enhanced recovery pathway" (ERP)
      for these patients. The PERFECTED programme is structured as 4 Work Packages (WPs); the
      primary aims of each are as follows:

        -  WP1: to establish best practice and define an ERP for patients with hip fracture and
           dementia in acute hospitals.

        -  WP2: to determine the staff training and cultural/organisational changes required to
           implement and maximise adherence to the aforementioned ERP.

        -  WP3: to undertake a pilot study to assess the clinical and cost effectiveness of the ERP
           that will inform the design of a future definitive Randomised Controlled Trial.

        -  WP4: to disseminate the data and lessons learned from the programme and develop a
           definitive trial proposal.

      This protocol relates to phase 3 of WP1 only. This specific phase is an observational study
      and involves researchers observing care delivery in specified ortho-geriatric wards at the
      Norfolk and Norwich University Hospital (NNUH), the Queen's Medical Centre (QMC) Nottingham
      and the Bradford Royal Infirmary (BRI). Observations will also take place in the Emergency
      Department (ED) of each of these hospitals on an opportunistic basis. Observations will occur
      in each of the sites intermittently over a 4-week period sequentially and will cover the full
      24h cycle. That is, we will do 4 weeks of observations at the NNUH, before moving to BRI and
      observing for 4 weeks, and then finish by undertaking 4 weeks of observations at QMC. Data
      elicited from these observations will address this study's research aims and will also inform
      the wider aims of WP1 by describing the context (including cost consequences) of care
      delivery to hospital patients with hip fracture, some of whom will have dementia. It is
      essential to emphasise that although PERFECTED overall (including WP1) is concerned with
      older hip-fracture patients who have dementia, phase 3 WP1 (this observational study) is
      concerned with all older hip-fracture patients in general.

      As a research programme PERFECTED is iterative. To create one total ethical protocol would
      not be feasible. We will be submitting numerous protocols in line with the programme's
      development. The aims, procedures and ethical considerations associated with phase 3 WP1, the
      observational study, are the sole objectives of this protocol.
observational model: Cohort
time perspective: Prospective
measure: To observe and describe the general day-to-day practices and routines in three English acute hospitals for treating older patients with hip fracture.
time frame: Observations in each of the 3 sites will take place for a 4 week period.
description: The overall aim of this study (phase 3, WP1 of PERFECTED) is to observe and describe the general day-to-day practices and routines in three English acute hospitals for treating older patients with hip fracture. The influence on care practices of significant co-morbidities, particularly dementia, will especially be noted. Observations will take place in defined areas on specified ortho-geriatric wards and in EDs. The study's aims and objectives focus on the delivery of care. As such, the focus of the observations is solely upon those health professionals who routinely deliver care in the designated spaces.
arm group label: Site 1 Health Care Professionals
description: Observational research. This is a cohort of health care professionals working in site 1 in delivering to care to neck of femur patients.
arm group label: Site 2 Health Care Professionals
description: Observational research. This is a cohort of health care professionals working in site 2 in delivering to care to neck of femur patients.
arm group label: Site 3 Health Care Professionals
description: Observational research. This is a cohort of health care professionals working in site 3 in delivering to care to neck of femur patients.
intervention type: Other
intervention name: Observational study, not interventional
arm group label: Site 1 Health Care Professionals
arm group label: Site 2 Health Care Professionals
arm group label: Site 3 Health Care Professionals
study pop: 
sampling method: Non-Probability Sample
criteria: 
gender: All
minimum age: N/A
maximum age: N/A
healthy volunteers: No
last name: George C Fox
role: Principal Investigator
affiliation: University of East Anglia
url: http://www.perfected.ac.uk
description: PERFECTED Programme homepage
responsible party type: Sponsor
mesh term: Hip Fractures