{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T08:06:39Z","timestamp":1789200399528,"version":"build-2803163510"},"reference-count":128,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T00:00:00Z","timestamp":1749686400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Fragility Fracture Network"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: Malnutrition is a key contributor to poor outcomes in older adults with fragility fractures, increasing the risk of complications, functional decline, prolonged hospital stays, mortality, and healthcare costs. Substantial evidence limited to hip fracture supports early, interdisciplinary nutrition care. However, global audits reveal that most hip fracture patients do not receive recommended interventions. This quality improvement (QI) project aimed to co-create and test a pathway and toolkit to help apply evidence-based nutrition care in different fragility fracture settings globally. Methods: The SIMPLER Pathway and toolkit (SIMPLER) were developed through a multiphase, co-creation QI initiative (2018\u20132025), guided by the Knowledge-to-Action framework. Global experts and clinical teams synthesized evidence, identified the \u201cknow-do\u201d gap, and adapted SIMPLER to context through iterative action\u2013reflection cycles. The Model for Improvement guided team building, goal setting, testing changes, and measuring outcomes at pilot sites. Results: Over 100 co-creation activities between 2018 and 2025 engaged staff and patients to shape and refine SIMPLER. A global clinician survey (n = 308, 46 countries), two bi-national audits (n = 965, 63 hospitals), and qualitative interviews (n = 15) confirmed a widespread evidence-practice gap. The pathway and toolkit were pilot-tested in five hospitals across four countries, with action\u2013reflection cycles enabling continuous refinement of prioritized nutrition improvements tailored to the local context. Following endorsement in late 2024, 46 healthcare services in 23 countries have formally committed to implementing SIMPLER. Conclusions: The SIMPLER Nutrition Pathway provides a scalable, adaptable framework to support the delivery of evidence-based nutrition care in fragility fracture settings. A global evaluation is underway.<\/jats:p>","DOI":"10.3390\/nu17121987","type":"journal-article","created":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T11:47:07Z","timestamp":1749728827000},"page":"1987","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The SIMPLER Nutrition Pathway for Fragility Fractures: A Quality Improvement Initiative"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7217-3635","authenticated-orcid":false,"given":"Jack J.","family":"Bell","sequence":"first","affiliation":[{"name":"Faculty of Food Science and Nutrition, School of Health at the University of Iceland, 102 Reykjavik, Iceland"},{"name":"Fragility Fracture Network, 4053 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3766-2062","authenticated-orcid":false,"given":"Olof Gudny","family":"Geirsdottir","sequence":"additional","affiliation":[{"name":"Faculty of Food Science and Nutrition, School of Health at the University of Iceland, 102 Reykjavik, Iceland"},{"name":"Fragility Fracture Network, 4053 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4726-9106","authenticated-orcid":false,"given":"Antony","family":"Johansen","sequence":"additional","affiliation":[{"name":"Fragility Fracture Network, 4053 Basel, Switzerland"},{"name":"School of Medicine, University Hospital of Wales, Cardiff University, Cardiff CF14 4XW, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Santy-Tomlinson","sequence":"additional","affiliation":[{"name":"Fragility Fracture Network, 4053 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4811-669X","authenticated-orcid":false,"given":"Frede","family":"Frihagen","sequence":"additional","affiliation":[{"name":"Fragility Fracture Network, 4053 Basel, Switzerland"},{"name":"Department of Orthopaedic Surgery, \u00d8stfold Hospital Trust, 1712 Gr\u00e5lum, Norway"},{"name":"Institute of Clinical Medicine, University of Oslo, 0407 Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhona","family":"McGlasson","sequence":"additional","affiliation":[{"name":"Fragility Fracture Network, 4053 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Sutton","sequence":"additional","affiliation":[{"name":"Fragility Fracture Network, 4053 Basel, Switzerland"},{"name":"Department of Nursing and Midwifery, School of Health Sciences, College of Medicine and Health, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Hertz","sequence":"additional","affiliation":[{"name":"Fragility Fracture Network, 4053 Basel, Switzerland"},{"name":"Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent ST4 6QG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,12]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2025, May 02). 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