Hip fracture in older adults is a sentinel event that often triggers functional decline, loss of independence, and high early rehospitalization, in part because the hospital-to-home transition is fragmented and caregivers are underprepared [1] . Discharge Preparation Services (DPS) [2] operationalize continuity by integrating early dual-person assessment (patient and caregiver), individualized written plans, structured education, and light-touch follow-up to address both capacity (skills, knowledge, confidence) and context (home environment, available support) [3] [4] . Readiness for hospital discharge (RHD) is a modifiable intermediate outcome that should translate into safer recovery, better adherence to rehabilitation, and earlier problem recognition. Yet evidence for DPS after hip fracture within orthopedic wards remains limited, and few studies measure both patient and caregiver readiness alongside objective recovery metrics and short-term utilization [5] . To address this gap, we implemented a structured DPS and evaluated its effect on functional recovery (Harris Hip Score, Barthel Index) [6] , RHD for patients and caregivers, inpatient complications, length of stay, and 30-day unplanned readmission compared with routine care, hypothesizing the superiority of DPS across these outcomes.

Participants. Of the 92 enrolled, 83 completed (intervention 40; control 43). Baseline sociodemographic and clinical characteristics were comparable between groups (no significant differences).

Functional recovery. Across discharge, 1 month, and 3 months, the intervention group demonstrated superior recovery on the Harris Hip Score (HHS) total and key domains versus control (all P < 0.05 at discharge for total/function/ROM; all P < 0.001 at 1 and 3 months). Detailed between-group means at each timepoint are presented ( Table 1 ), and the repeated-measures ANOVA (time, group, and time × group interaction effects) is summarized ( Table 2 ).

Activities of daily living. The Barthel Index improved in both groups over time, with higher scores in the intervention group at discharge, 1 month, and 3 months (respectively P < 0.05, P < 0.001, P < 0.05). Summary statistics and between-group tests are shown ( Table 3 ); the repeated-measures ANOVA for Barthel appears in ( Table 4 ).

Readiness for hospital discharge. At discharge, both patient and caregiver RHD totals and all three dimensions were significantly higher in the intervention group than in controls (all P < 0.001). Patient and caregiver RHD results are detailed ( Table 5 , Table 6 ); the within-intervention comparison of patients versus caregivers is provided ( Table 7 ).

Safety and utilization. The composite inpatient complication rate was lower with DPS (10.00% vs 30.23%, P = 0.022), as summarized ( Table 8 ). The intervention group had a shorter length of stay (9.98 ± 2.68 vs 12.72 ± 5.03 days, P = 0.003) and fewer 30-day unplanned readmissions (5.00% vs 20.93%, P = 0.032), as shown ( Table 9 ).

This study shows that a structured Discharge Preparation Service meaningfully augments the standard perioperative pathway for older adults with hip fracture. Early dual-person assessment, individualized planning, targeted education, and light-touch remote follow-up created a continuous hospital-to-home bridge [7] . This mechanism plausibly improved self-management, caregiver alignment, and early identification of problems—reflected in higher readiness, faster functional gains, fewer inpatient complications, shorter stays, and lower 30-day readmissions [8] . Beyond patient education, the dual-person design likely acted through caregiver readiness as a mediator of outcomes: higher caregiver RHD improves alignment on rehabilitation goals, dosing/analgesia adherence, timely escalation of red-flags (fever, wound issues, uncontrolled pain), and safer ambulation support at home. These caregiver-dependent behaviors plausibly link the observed gains in HHS/Barthel to lower complications, shorter stays, and fewer early readmissions. The observed reduction in LOS (−2.74 days) and absolute decrease in 30-day readmission (−15.9%) suggest DPS is likely cost-saving from a hospital perspective by freeing bed-days and avoiding penalty-prone readmissions; a formal cost-effectiveness analysis is warranted to quantify budget impact and return on investment.

Two implementation lessons emerge. First, readiness is an actionable, measurable intermediate endpoint: flag low subdomains early and tailor education/referrals accordingly [9] . Second, simple digital follow-ups (phone/WeChat) maintained adherence without adding clinic congestion, enabling timely micro-adjustments in home rehabilitation.

Limitations include the single-center design, modest sample size, and a 3-month follow-up window that cannot capture long-term outcomes. Future multicenter studies with longer follow-up and stratification are warranted.

A structured Discharge Preparation Service for older adults with hip fracture improved postoperative function and ADL, enhanced discharge readiness for patients and caregivers, reduced inpatient complications, shortened length of stay, and lowered 30-day unplanned readmissions. DPS is feasible to operationalize on orthopedic wards and should be integrated with community rehabilitation through a clear referral-and-feedback loop.

Abbreviations: DPS, Discharge Preparation Service; ROM, range of motion; RHD, Readiness for Hospital Discharge; LOS, length of stay; ns, not significant (>0.05). “*” P < 0.05; “**” P < 0.001; “—” not applicable. Group sizes: intervention n = 40; control n = 43.

*Corresponding author.