Implementing a fracture liaison service open model of care utilizing a cloud-based tool

Osteoporos Int. 2018 Apr;29(4):953-960. doi: 10.1007/s00198-017-4371-y. Epub 2018 Feb 10.

Abstract

Purpose: Although half of women and one-quarter of men aged 50 and older will sustain an acute low-trauma fracture, less than a quarter receive appropriate secondary fracture prevention. The goal of this quality improvement demonstration project was to implement a Fracture Liaison Service (FLS) focused on secondary prevention of an osteoporotic fracture in three open health care systems aided by a cloud-based tool.

Methods: The pre-post study design examined the proportion of men and women over age 50 who received appropriate assessment (bone mineral density, vitamin D levels) and treatment (calcium/vitamin D, pharmacologic therapy) in the six months following a recently diagnosed fracture. The pre-study (Pre FLS) included a retrospective chart review for baseline data (N = 344 patients) within each health care system. In the post-evaluation (Post FLS, N = 148 patients), the FLS coordinator from each health care system examined these parameters following enrollment and for 6 months following the recently diagnosed fracture. Data were managed in the cloud-based FLS application tool.

Results: Ninety-three participants completed the program. The FLS program increased the percentage of patients receiving bone mineral density testing from 21% at baseline to 93% (p < 0.001) Post FLS implementation. Assessments of vitamin D levels increased from 25 to 84% (p < 0.001). Patients prescribed calcium/vitamin D increased from 36% at baseline to 93% (p < 0.001) and those prescribed pharmacologic treatment for osteoporosis increased on average from 20 to 54% (p < 0.001) Post FLS.

Conclusions: We conclude that the FLS model of care in an open health care system, assisted by a cloud-based tool, significantly improved assessment and/or treatment of patients with a recently diagnosed osteoporotic fracture. Future studies are necessary to determine if this model of care is scalable and if such programs result in prevention of fractures. Mini-Abstract: The goal was to implement a Fracture Liaison Service (FLS) focused on secondary prevention of an osteoporotic fracture in open health care systems aided by a cloud-based tool. This model significantly improved assessment and/or treatment of patients with a recently diagnosed fracture.

Keywords: Bone mineral density; Calcium; Fracture; Fracture Liaison Service; Osteoporosis; Vitamin D.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon / methods
  • Aged
  • Bone Density / physiology
  • Bone Density Conservation Agents / therapeutic use
  • Calcium / therapeutic use
  • Cloud Computing
  • Delivery of Health Care, Integrated / organization & administration*
  • Dietary Supplements
  • Drug Utilization / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • Models, Organizational*
  • Osteoporosis / diagnosis
  • Osteoporosis / drug therapy
  • Osteoporosis / physiopathology
  • Osteoporotic Fractures / physiopathology
  • Osteoporotic Fractures / prevention & control*
  • Retrospective Studies
  • Secondary Prevention / organization & administration
  • United States
  • Vitamin D / therapeutic use

Substances

  • Bone Density Conservation Agents
  • Vitamin D
  • Calcium