INTRODUCTION: Patients with prior fracture have double the risk of subsequent fractures. One vertebral fracture can increase the risk of another 2-5 times. Despite this, less than 5% of patients with fragility fractures receive adequate osteoporosis evaluation after fracture to reduce recurrent fracture risk and disability. Annual costs of osteoporotic fractures are tremendous ( $17 billion, 2001). As these fractures occur more in the elderly, co-morbidities are the rule, and not the exception. With a 20% increased prevalence expected in the next decade (and exponentially thereafter), it is unrealistic to expect the orthopaedic service of any hospital system to manage a public health issue of this scope alone. (Appendix I)
AIMS: 1. Develop a multi-disciplinary model of care to reduce fracture recurrence by identifying patients at high risk for osteoporosis, and coordinating education, screening and treatment via a centralized, physician-extender-driven network of innovative health care initiatives which connect the orthopaedic service to medical, rehabilitation, and community education services for osteoporosis care follow-up. 2. Optimize patient's bone health, and surgical/rehabilitation outcomes. 3. Maintain patient privacy and integrity of health care provider decision-making. 4. Standardize clinical pathways and an efficient communication network, and orchestrate them in hospital and community with nurse educators, to optimize costs, dedicated physician-time and breadth of medical management. (Appendix II).
METHODS: 1. Establish hospital's baseline osteoporosis care for these patients via medical record review of targeted ICD-9 Fracture Codes, and percentage of patients with concomitant low bone mineral density ICD-9 code assignment (733.0) (Appendix III). 2. Target those patients within the hospital Emergency Department at highest-risk for osteoporosis: peri- and post-menopausal women, males >65 years old, and thin, young female athletes. 3. Nurse educators assess patients' knowledge of osteoporosis risk factors, provide education and encouragement to designate a physician for further risk assessment, communicate with said physician(s), and assist orthopaedic service in discharge planning. 4. Target rehabilitation facilities, long term care facilities, home health services and out-patient physician offices for follow-up. (Appendix IV).
RESULTS 1. Creation of a new standard of care for medical screening and treatment of osteoporosis, and prevention of fracture recurrence, without burdening or disrupting orthopaedic service operation. 2. Reduction of medical oversights/loss - to - follow-up via standardized post-fracture screening and treatment pathways by physicians and nurse educators. 3. Appropriate patient access to osteoporosis screening and treatment, including the uninsured. 4. Reduce health care delivery costs via centralized oversight of the program (i.e, nurse administration-driven initiative), judicious use of medical information system technology and physician extenders, early diagnosis/treatment, and increased patient responsibility. 5. Innovative community education initiatives for bone health throughout life, from elementary school to geriatric units, with ties to obesity reduction initatives (“Healthy Bones, Healthy Bodies”). 6. Partnerships with state, federal, health industry and non-profit educational initiatives. 7. Creation of a prototype adaptable to varied public health initiatives, providing community-building opportunities into new markets for the dynamic hospital system, which creates a virtual health care system to better serve the 21st century public.
CONCLUSION This design creates a healthcare matrix to capture fracture patients at risk for osteoporosis, and provide them with appropriate, reimburseable health care services in an efficient manner. It is nurse-driven, to contain costs. It expands virtually every hospital's department capability, but seamlessly. By increasing the likelihood of capturing one diagnosis very frequently, it creates a model to capture any health initiative target just as efficiently. Orchestrated by the hospital administration, and facilitated by pre-existing hospital services (i.e., radiology, laboratory, nutrition and medical information systems), it permits optimal use of physician expertise with minimal new cost outlays.
Disclosure Information:
Faculty Member's Name: Patricia A. Graham, MD
I have no relationships to disclose.
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