Lessons Learned : Evaluation of Fracture Liaison Service Quality Improvement Efforts in a Large Academic Healthcare System
© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine..
BACKGROUND: The Fracture Liaison Service (FLS) care model, a care coordination program for patients experiencing a fragility fracture, is proven to improve management of patients with an osteoporotic fracture, but treatment initiation gaps persist.
OBJECTIVE: We describe the evolution of a centralized FLS within a university-based healthcare system, including impact of adding clinical pharmacist consultation, and describe circumstances surrounding continued care gaps.
DESIGN: Cohort analysis of osteoporosis medication initiation before FLS, after initial implementation, and after addition of pharmacist consultation.
PATIENTS: Individuals aged 65 and older experiencing any fragility fracture between 7/1/16 and 3/31/22.
INTERVENTION: A centralized team outreached eligible patients, ordered dual x-ray absorptiometry and laboratory tests as needed, and scheduled an osteoporosis-focused primary care appointment. Three years after FLS implementation, clinical pharmacist consultative review was added prior to the primary care visit.
MAIN MEASURES: Initiation of osteoporosis pharmacologic therapy, completion of DXA, primary care follow-up rate, and description of circumstances where therapy was not initiated.
KEY RESULTS: Of 1204 new fractures between 7/1/16 and 3/31/22, 315 patients were enrolled in one of two FLS phases, and 89 eligible historical controls were identified. Medication initiation rates went from 22/89 (25%) pre-FLS to 201/428 (47%) after-FLS phase 1 [POST1] (p<0.001) and to 106/187 (57%) after FLS phase 2 (POST2), when clinical pharmacist consultation was added (p=0.03 versus POST1). DXA was completed in 56/89 (67%) of pre-FLS patients, 364/428 (85%) POST1 patients (p<0.001 versus pre), and 163/187 (87%) POST2 (p< 0.001 versus PRE, p=0.59 versus POST1). Of 375 patients who did not initiate osteoporosis medication, more in the combined post-FLS cohorts attended a follow-up primary care appointment (233/308, 76% attended, versus pre-FLS 41/67, 61%, p=0.016).
CONCLUSION: An FLS including centralized outreach and care coordination significantly improved patient follow-up, DXA, and medication initiation. Addition of de-centralized pharmacist consultation further improved medication initiation rates.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2023 |
|---|---|
| Enthalten in: |
Journal of general internal medicine - (2023) vom: 15. Dez. |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Billups, Sarah J [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Clinical pharmacist |
|---|
| Anmerkungen: |
Date Revised 15.12.2023 published: Print-Electronic Citation Status Publisher |
|---|
| doi: |
10.1007/s11606-023-08568-8 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM365907030 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM365907030 | ||
| 003 | DE-627 | ||
| 005 | 20231227132538.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231227s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1007/s11606-023-08568-8 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1228.xml |
| 035 | |a (DE-627)NLM365907030 | ||
| 035 | |a (NLM)38100010 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Billups, Sarah J |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Lessons Learned |b Evaluation of Fracture Liaison Service Quality Improvement Efforts in a Large Academic Healthcare System |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 15.12.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © 2023. The Author(s), under exclusive licence to Society of General Internal Medicine. | ||
| 520 | |a BACKGROUND: The Fracture Liaison Service (FLS) care model, a care coordination program for patients experiencing a fragility fracture, is proven to improve management of patients with an osteoporotic fracture, but treatment initiation gaps persist | ||
| 520 | |a OBJECTIVE: We describe the evolution of a centralized FLS within a university-based healthcare system, including impact of adding clinical pharmacist consultation, and describe circumstances surrounding continued care gaps | ||
| 520 | |a DESIGN: Cohort analysis of osteoporosis medication initiation before FLS, after initial implementation, and after addition of pharmacist consultation | ||
| 520 | |a PATIENTS: Individuals aged 65 and older experiencing any fragility fracture between 7/1/16 and 3/31/22 | ||
| 520 | |a INTERVENTION: A centralized team outreached eligible patients, ordered dual x-ray absorptiometry and laboratory tests as needed, and scheduled an osteoporosis-focused primary care appointment. Three years after FLS implementation, clinical pharmacist consultative review was added prior to the primary care visit | ||
| 520 | |a MAIN MEASURES: Initiation of osteoporosis pharmacologic therapy, completion of DXA, primary care follow-up rate, and description of circumstances where therapy was not initiated | ||
| 520 | |a KEY RESULTS: Of 1204 new fractures between 7/1/16 and 3/31/22, 315 patients were enrolled in one of two FLS phases, and 89 eligible historical controls were identified. Medication initiation rates went from 22/89 (25%) pre-FLS to 201/428 (47%) after-FLS phase 1 [POST1] (p<0.001) and to 106/187 (57%) after FLS phase 2 (POST2), when clinical pharmacist consultation was added (p=0.03 versus POST1). DXA was completed in 56/89 (67%) of pre-FLS patients, 364/428 (85%) POST1 patients (p<0.001 versus pre), and 163/187 (87%) POST2 (p< 0.001 versus PRE, p=0.59 versus POST1). Of 375 patients who did not initiate osteoporosis medication, more in the combined post-FLS cohorts attended a follow-up primary care appointment (233/308, 76% attended, versus pre-FLS 41/67, 61%, p=0.016) | ||
| 520 | |a CONCLUSION: An FLS including centralized outreach and care coordination significantly improved patient follow-up, DXA, and medication initiation. Addition of de-centralized pharmacist consultation further improved medication initiation rates | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a clinical pharmacist | |
| 650 | 4 | |a fracture Liaison Service | |
| 650 | 4 | |a osteoporosis | |
| 650 | 4 | |a primary care. | |
| 650 | 4 | |a treatment gap | |
| 700 | 1 | |a Fixen, Danielle R |e verfasserin |4 aut | |
| 700 | 1 | |a Schilling, Lisa M |e verfasserin |4 aut | |
| 700 | 1 | |a El-Sheikh, Arwa |e verfasserin |4 aut | |
| 700 | 1 | |a Marcus, Alexandra M |e verfasserin |4 aut | |
| 700 | 1 | |a Rothman, Micol S |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of general internal medicine |d 1986 |g (2023) vom: 15. Dez. |w (DE-627)NLM01293612X |x 1525-1497 |7 nnns |
| 773 | 1 | 8 | |g year:2023 |g day:15 |g month:12 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1007/s11606-023-08568-8 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |j 2023 |b 15 |c 12 | ||