scholarly journals A Hospitalist-Led Fracture Liaison Service Improves Care of Hip Fracture Patients

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A241-A241
Author(s):  
Anne Drabkin ◽  
Micol Sara Rothman ◽  
Goold Audrey ◽  
Yasui Robin ◽  
Mancini Diana
Keyword(s):  
Vitamin D ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Hip Fractures ◽  
Primary Care Providers ◽  
The United States ◽  
Fracture Liaison Service ◽  
Care Providers ◽  
Osteoporosis Care ◽  
Fracture Liaison

Abstract Background: Osteoporosis care traditionally falls to outpatient primary care providers despite the fact that over 300,000 elderly patients are hospitalized yearly with hip fractures in the United States. Internal medicine hospitalists are often involved in the co-management of their care on surgical teams and are skillful in osteoporosis recognition and management. Objective: A hospitalist-led Fracture Liaison Service (FLS) was established to provide improved care of hospitalized patients with hip fractures. Methods: A retrospective evaluation of inpatient and post-discharge management of patients admitted with low-impact hip fractures was performed before (8/17-2/18) and after (8/19 - 2/20) launch of the hospitalist Fracture Liaison Service (H-FLS). Results: Eighty-nine patients were admitted with a hip fracture in post-launch period compared to 73 admitted prior. 74% vs 11% of eligible patients (based on adequate renal function and vitamin D stores) were discharged with anti-osteoporosis medications (p<0.001), 82% vs 38% were discharged with vitamin D/calcium supplements (p<0.001), 22% vs 5% underwent a DXA scan after discharge (p<0.05) and 65% vs 0% were referred to outpatient osteoporosis-specific care at discharge (p<0.001). Conclusion: A hospitalist-led FLS is a unique approach to osteoporosis care that significantly improved quality metrics for elderly patients with osteoporotic hip fractures including initiation of anti-osteoporosis medication and bone density imaging. Outpatient follow-up data are needed to evaluate adherence to this initial management over time.

scholarly journals Outcome of nonoperative treatment for hip fractures in elderly patients: A systematic review of recent literature

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902093684
Author(s):  
Seung-Ju Kim ◽  
Hyun-Soo Park ◽  
Dong-Woo Lee
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Health Care Providers ◽  
Hip Fractures ◽  
Fragility Fractures ◽  
Nonoperative Treatment ◽  
Cochrane Library ◽  
Care Providers ◽  
Nonsurgical Management ◽  
Tract Infections

Many studies have shown that surgical management still leads to the best outcomes in elderly patients with hip fractures, with some studies showing non-inferiority of nonsurgical management as compared to surgery in fragility fractures. Evidence-based guidelines on whether to operate on these patients are lacking. A systematic literature search was conducted regarding outcomes of nonoperatively treated hip fractures in elderly patients with various comorbidities. A structured literature review of multiple databases (PubMed, Web of Science, EMBASE, and Cochrane library) referenced articles from 2000 to 2020. A total of 596 patients from 11 published studies were identified. Mean age was 83.3 years. Overall 328 (69.7%) complications occurred in 470 patients with nonsurgical treatment. Pneumonia and urinary tract infections were the most common complications which occurred in 53 (16.1%) and 46 (14.0%) patients, respectively. Hip fracture patients who were treated nonoperatively had a higher in-hospital (17.1% vs. 4.4%; p < 0.001), 30-day (31.4% vs. 10.2%; p < 0.001), and 1-year (48.5% vs. 19.9%; p < 0.001) mortality compared to a matched group of operatively treated patients ( n = 1464). Of the 110 patients whose reported cause of death was nonoperative care, 44 (40%) was due to pneumonia. Patients with nonoperative treatment following hip fracture were associated with substantially higher complication and mortality compared with patients who were treated operatively. Our study will help health-care providers and caregivers to enable more informed decision-making for families and patients confronted with a hip fracture.

scholarly journals O02 Is vitamin D testing essential in elderly patients with a hip fracture?

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Serena N Mehta ◽  
Mohd K Omar ◽  
Hem Sapkota
Keyword(s):  
Vitamin D ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Hip Fractures ◽  
Osteoporosis Treatment ◽  
Vitamin D Supplementation ◽  
High Dose ◽  
Medication History ◽  
Vitamin D Levels ◽  
High Dose Vitamin

Abstract Background Elderly patients with hip fractures are likely to be vitamin D deficient. As per some studies, a vitamin D level above 75nmol/L is considered to be sufficient for this cohort. The majority of these patients will require treatment for their osteoporosis. Prior to treatment, vitamin D levels need to be sufficient, however there is often a delay to obtain vitamin D test results and this can postpone the initiation of osteoporosis management. In this retrospective study, we hypothesised whether empirical, high dose vitamin D treatment can be given to patients with hip fractures, regardless of their vitamin D level, who are not currently on vitamin D supplementation. Methods We obtained a list of 917 patients with a hip fracture, aged over 50, from the Trust National Hip Fracture Database from January 2017 to December 2018. We accessed patients’ electronic hospital and GP records to collect patient demographics, vitamin D levels, and medication history. Results The mean age in this study was 82.7 years, and 69.8% were female. Vitamin D levels were available for 666 patients. Of this, 69.9% of patients had a below adequate level (50 nmol/L) and 88.4% of patients had a below sufficient level (75 nmol/L) of vitamin D. Electronic records for vitamin D supplementation were only available for 434 patients. Of this, 300 patients (69.1%) were not on any form of vitamin D supplementation. In this cohort, only 7 patients had a vitamin D level above sufficient levels (75 nmol/L). Upon contacting these 7 patients; 3 were taking some form of vitamin D supplementation, 3 died and no information was available for 1. Conclusion Our study demonstrates all patients with a hip fracture, who are not taking any form of vitamin D supplementation will have subtherapeutic vitamin D levels. Thus, patients presenting with a hip fracture, can be treated empirically with high dose vitamin D treatment, without prior vitamin D testing. This would reduce the number of vitamin D tests conducted by 69.1% which will enable patients to receive prompt osteoporosis treatment and will reduce costs. Disclosures S.N. Mehta None. M.K. Omar None. H. Sapkota None.

scholarly journals Fracture Liaison Service to Reduce Postoperative Complications and Improve the Activity of Patients With Hip Fracture: A 24-month Follow-up Survey

2020 ◽  
Author(s):  
Norio Imai ◽  
Naoto Endo ◽  
Ken Suda ◽  
Hayato Suzuki
Keyword(s):  
Hip Fracture ◽  
Postoperative Complications ◽  
Hip Fractures ◽  
Medical Information ◽  
Multiple Logistic Regression Analysis ◽  
Fracture Liaison Service ◽  
University Hospital ◽  
Medical Complications ◽  
Control Group ◽  
Fracture Liaison

Abstract Background: Many models of fracture liaison services (FLS) following hip fracture have been introduced in the United Kingdom and Japan, resulting in a reduction in medical complications and secondary fractures. This study investigated improvements in time to surgery, daily activity, and the rate of medical complications and secondary hip fractures following the introduction of FLS.Methods: Patients who were over 50 years old and experienced fragility hip fractures, including femoral neck and trochanteric fractures, between January 1, 2015 and December 31, 2017, were enrolled in the study. We divided patients into a control group without FLS (94 patients; mean age: 83.8 years; 21 men and 73 women) and an FLS group (373 patients; mean age: 83.3 years; 69 men and 304 women).Results: The time from injury to surgery decreased significantly from 2.42 days to 1.83 days following the introduction of FLS (p = 0.003). The proportion of patients who were able to undergo surgery within 36 hours of injury also increased significantly in the FLS group (p = 0.014). In the FLS group, a significant decrease was observed in the total number of cases with complications, including cardiovascular disease, pulmonary disease, and cerebrovascular disease, after admission (p = 0.009, 0.010, 0.043, respectively). Significantly more patients with a Barthel index (BI) of ≥80 were observed in the FLS group at 6 months, 12 months, and 24 months following injury (p = 0.046, 0.018, and 0.048, respectively). Multiple logistic regression analysis revealed that BI at the time of injury, surgery within 36 hours of injury, and postoperative complications were associated with death within 12 or 24 months after the injury.Conclusions: Our results indicate that FLS contributed to earlier recovery and rehabilitation following surgery, and accelerated rehabilitation of medical complications following admission. Our FLS is expected to improve patient activity and decrease secondary hip fracture in patients who have undergone hip surgery. Trial registration: University Hospital Medical Information Clinical Trials Registry, UMIN000041206. Registered 24th July 2020, https://upload.umin.ac.jp/cgi-in/ctr/ctr_view_reg.cgi?recptno=R000047054

scholarly journals 72 Surviving the Epidemic That Confronts Us—Fracture Liaison Service Evaluation Data

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
T Larcombe ◽  
R A Lisk ◽  
K F Yeong
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Significant Proportion ◽  
Surrogate Marker ◽  
Service Evaluation ◽  
Fracture Liaison Service ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Number Of Patients ◽  
Fracture Liaison

Abstract Introduction 1 in 2 women and 1 in 5 men over the age of 50 will break a bone and a significant proportion will suffer from osteoporosis.A fragility fracture will double the risk of future fractures. Between 1990 and 2000, there was nearly a 25% increase in hip fractures worldwide. A hip fracture is one of the most devastating, and often terminal, injury for an older person. Intervention The Fracture Liaison Service (FLS) captures patients aged 50 and above that present to fracture clinic with possible fragility fractures with the aim to reduce further fracture incidence. Patients are assessed for osteoporosis and recommendations made for treatment. Results Here we present the results of our FLS service evaluation after 6 years in operation, using the rate of hip fractures (number of hip fractures/Emergency Department [ED] attendances over 75’s) as a surrogate marker for effectiveness. Evaluation Summary Trend analysis of our data indicates a reduction in the number of patients attending the Trust with fractured neck of femur (NOF) despite the increase in ED attendances. This is against the trend nationally where fractured NOF numbers are rising (National Hip Fracture Database, accessed online August 2019). Next steps The FLS to attempt to comprehensively capture muscular-skeletal patients and to consider opportunities present to target case finding to high risk cohorts.

Systematic approaches to fragility fracture prevention

2014 ◽  
Vol 23 (01) ◽  
pp. 39-44
Author(s):  
D. B. Lee ◽  
P. J. Mitchell
Keyword(s):  
Fragility Fracture ◽  
National Policy ◽  
Fragility Fractures ◽  
Fracture Prevention ◽  
The United States ◽  
Fracture Liaison Service ◽  
Reimbursement Mechanisms ◽  
Future Fracture ◽  
National Coalition ◽  
Fracture Liaison

SummaryIndividuals who have suffered fractures caused by osteoporosis – also known as fragility fractures – are the most readily identifiable group at high risk of suffering future fractures. Globally, the majority of these individuals do not receive the secondary preventive care that they need. The Fracture Liaison Service model (FLS) has been developed to ensure that fragility fracture patients are reliably identified, investigated for future fracture and falls risk, and initiated on treatment in accordance with national clinical guidelines. FLS have been successfully established in Asia, Europe, Latin America, North America and Oceania, and their widespread implementation is endorsed by leading national and international osteoporosis organisations. Multi-sector coalitions have expedited inclusion of FLS into national policy and reimbursement mechanisms. The largest national coalition, the National Bone Health Alliance (NBHA) in the United States, provides an exemplar of achieving participation and consensus across sectors. Initiatives developed by NBHA could serve to inform activities of new and emerging coalitions in other countries.

scholarly journals 145. Monthly Antibiotic Prescribing Peer Comparison Combined with In-person Education Decreases Antibiotic Prescribing for Acute Respiratory Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S83-S83
Author(s):  
Shelby J Kolo ◽  
David J Taber ◽  
Ronald G Washburn ◽  
Katherine A Pleasants
Keyword(s):  
Primary Care ◽  
Respiratory Infections ◽  
Primary Care Providers ◽  
The United States ◽  
Delivery Mode ◽  
Antibiotic Prescribing ◽  
Acute Respiratory Infections ◽  
Care Providers ◽  
Intervention Period ◽  
Provider Education

Abstract Background Inappropriate antibiotic prescribing is an important modifiable risk factor for antibiotic resistance. Approximately half of all antibiotics prescribed for acute respiratory infections (ARIs) in the United States may be inappropriate or unnecessary. The purpose of this quality improvement (QI) project was to evaluate the effect of three consecutive interventions on improving antibiotic prescribing for ARIs (i.e., pharyngitis, rhinosinusitis, bronchitis, common cold). Methods This was a pre-post analysis of an antimicrobial stewardship QI initiative to improve antibiotic prescribing for ARIs in six Veterans Affairs (VA) primary care clinics. Three distinct intervention phases occurred. Educational interventions included training on appropriate antibiotic prescribing for ARIs. During the first intervention period (8/2017-1/2019), education was presented virtually to primary care providers on a single occasion. In the second intervention period (2/2019-10/2019), in-person education with peer comparison was presented on a single occasion. In the third intervention period (11/2019-4/2020), education and prescribing feedback with peer comparison was presented once in-person followed by monthly emails of prescribing feedback with peer comparison. January 2016-July 2017 was used as a pre-intervention baseline period. The primary outcome was the antibiotic prescribing rate for all classifications of ARIs. Secondary outcomes included adherence to antibiotic prescribing guidance for pharyngitis and rhinosinusitis. Descriptive statistics and interrupted time series segmented regression were used to analyze the outcomes. Results Monthly antibiotic prescribing peer comparison emails in combination with in-person education was associated with a statistically significant 12.5% reduction in the rate of antibiotic prescribing for ARIs (p=0.0019). When provider education alone was used, the reduction in antibiotic prescribing was nonsignificant. Conclusion Education alone does not significantly reduce antibiotic prescribing for ARIs, regardless of the delivery mode. In contrast, education followed by monthly prescribing feedback with peer comparison was associated with a statistically significant reduction in ARI antibiotic prescribing rates. Disclosures All Authors: No reported disclosures

scholarly journals Complementary and Integrative Health Knowledge and Practice in Primary Care Settings: A Survey of Primary Care Providers in the Northwestern United States

2021 ◽  
Vol 10 ◽  
pp. 216495612110233
Author(s):  
Malaika R Schwartz ◽  
Allison M Cole ◽  
Gina A Keppel ◽  
Ryan Gilles ◽  
John Holmes ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Knowledge ◽  
Care Delivery ◽  
Primary Care Providers ◽  
The United States ◽  
Research Network ◽  
Care Providers ◽  
Integrative Health ◽  
And Training

Background The demand for complementary and integrative health (CIH) is increasing by patients who want to receive more CIH referrals, in-clinic services, and overall care delivery. To promote CIH within the context of primary care, it is critical that providers have sufficient knowledge of CIH, access to CIH-trained providers for referral purposes, and are comfortable either providing services or co-managing patients who favor a CIH approach to their healthcare. Objective The main objective was to gather primary care providers’ perspectives across the northwestern region of the United States on their CIH familiarity and knowledge, clinic barriers and opportunities, and education and training needs. Methods We conducted an online, quantitative survey through an email invitation to all primary care providers (n = 483) at 11 primary care organizations from the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region Practice and Research Network (WPRN). The survey questions covered talking about CIH with patients, co-managing care with CIH providers, familiarity with and training in CIH modalities, clinic barriers to CIH integration, and interest in learning more about CIH modalities. Results 218 primary care providers completed the survey (45% response rate). Familiarity with individual CIH methods ranged from 73% (chiropracty) to 8% (curanderismo). Most respondents discussed CIH with their patients (88%), and many thought that their patients could benefit from CIH (41%). The majority (89%) were willing to co-manage a patient with a CIH provider. Approximately one-third of respondents had some expertise in at least one CIH modality. Over 78% were interested in learning more about the safety and efficacy of at least one CIH modality. Conclusion Primary care providers in the Northwestern United States are generally familiar with CIH modalities, are interested in referring and co-managing care with CIH providers, and would like to have more learning opportunities to increase knowledge of CIH.

scholarly journals VitalSign6: A Primary Care First (PCP-First) Model for Universal Screening and Measurement-Based Care for Depression

2019 ◽  
Vol 12 (2) ◽  
pp. 71 ◽  
Author(s):  
Madhukar Trivedi ◽  
Manish Jha ◽  
Farra Kahalnik ◽  
Ronny Pipes ◽  
Sara Levinson ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Universal Screening ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Similar Treatment ◽  
Measurement Based Care

Major depressive disorder affects one in five adults in the United States. While practice guidelines recommend universal screening for depression in primary care settings, clinical outcomes suffer in the absence of optimal models to manage those who screen positive for depression. The current practice of employing additional mental health professionals perpetuates the assumption that primary care providers (PCP) cannot effectively manage depression, which is not feasible, due to the added costs and shortage of mental health professionals. We have extended our previous work, which demonstrated similar treatment outcomes for depression in primary care and psychiatric settings, using measurement-based care (MBC) by developing a model, called Primary Care First (PCP-First), that empowers PCPs to effectively manage depression in their patients. This model incorporates health information technology tools, through an electronic health records (EHR) integrated web-application and facilitates the following five components: (1) Screening (2) diagnosis (3) treatment selection (4) treatment implementation and (5) treatment revision. We have implemented this model as part of a quality improvement project, called VitalSign6, and will measure its success using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. In this report, we provide the background and rationale of the PCP-First model and the operationalization of VitalSign6 project.

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