Successes and failures in improving osteoporosis care after fragility fracture: Results of a multiple-site clinical improvement project

Authors

  • J. Timothy Harrington,

    Corresponding author
    1. University of Wisconsin School of Medicine and Public Health, Madison
    • University of Wisconsin School of Medicine and Public Health, One South Park Street, Madison, WI 53715
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    • Dr. Harrington has received consulting fees (more than $10,000 per year) from the Alliance for Better Bone Health, and is the inventor of Stop Osteoporosis software (copyrighted by the Wisconsin Alumni Research Foundation). Dr. Deal has received consulting fees (more than $10,000 per year each) from Eli Lilly and GlaxoSmithKline/Roche.

  • Chad L. Deal

    1. Cleveland Clinic Foundation, Cleveland, Ohio
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    • Dr. Harrington has received consulting fees (more than $10,000 per year) from the Alliance for Better Bone Health, and is the inventor of Stop Osteoporosis software (copyrighted by the Wisconsin Alumni Research Foundation). Dr. Deal has received consulting fees (more than $10,000 per year each) from Eli Lilly and GlaxoSmithKline/Roche.


Abstract

Objective

To improve osteoporosis diagnosis and treatment of fragility fracture patient populations because osteoporosis care is provided infrequently to those patients, leaving them vulnerable to further fractures and increasing debility.

Methods

Osteoporosis experts from 11 US health systems participated in a clinical improvement project based on previously described successful osteoporosis care process redesigns. Participants were taught rapid cycle process improvement methods that are widely used in clinical improvement projects, and were supported in their efforts by the program coordinator. Measures of successful process development included establishing reliable referral from orthopedic fracture care to osteoporosis diagnosis and treatment, nurse coordination and monitoring of osteoporosis care, and use of process management software for registering patients and organizing work.

Results

Four sites were able to establish these critical referral and osteoporosis management processes. Two sites were partially successful in increasing orthopedic referrals to consultative care, but otherwise continued traditional care processes. Five were unsuccessful due to inability to implement 1 or more of these key process improvements.

Conclusion

Reliable osteoporosis care for fracture patients is possible if traditional practice processes are replaced with more effective, well-recognized approaches to chronic disease management.

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