Redesigning the care of fragility fracture patients to improve osteoporosis management: A health care improvement project
Article first published online: 7 APR 2005
Copyright © 2005 by the American College of Rheumatology
Arthritis Care & Research
Volume 53, Issue 2, pages 198–204, 15 April 2005
How to Cite
Harrington, J. T., Barash, H. L., Day, S. and Lease, J. (2005), Redesigning the care of fragility fracture patients to improve osteoporosis management: A health care improvement project. Arthritis & Rheumatism, 53: 198–204. doi: 10.1002/art.21072
- Issue published online: 7 APR 2005
- Article first published online: 7 APR 2005
- Manuscript Accepted: 6 OCT 2004
- Manuscript Received: 9 FEB 2004
- Alliance for Better Bone Health (Procter & Gamble and Aventis Pharmaceuticals)
- Clinical process redesign
To develop new processes that assure more reliable, population-based care of fragility fracture patients.
A 4-year clinical improvement project was performed in a multispecialty, community practice health system using evidence-based guidelines and rapid cycle process improvement methods (plan-do-study-act cycles).
Prior to this project, appropriate osteoporosis care was provided to only 5% of our 1999 hip fracture patients. In 2001, primary physicians were provided prompts about appropriate care (cycle 1), which resulted in improved care for only 20% of patients. A process improvement pilot in 2002 (cycle 2) and full program implementation in 2003 (cycle 3) have assured osteoporosis care for all willing and able patients with any fragility fracture. Altogether, 58% of 2003 fragility fracture patients, including 46% of those with hip fracture, have had a bone measurement, have been assigned to osteoporosis care with their primary physician or a consultant, and are being monitored regularly. Only 19% refused osteoporosis care. Key process improvements have included using orthopedic billings to identify patients, referring patients directly from orthopedics to an osteoporosis care program, organizing care with a nurse manager and process management computer software, assigning patients to primary or consultative physician care based on disease severity, and monitoring adherence to therapy by telephone.
Reliable osteoporosis care is achievable by redesigning clinical processes. Performance data motivate physicians to reconsider traditional approaches. Improving the care of osteoporosis and other chronic diseases requires coordinated care across specialty boundaries and health system support.