Early findings of a technology driven FLS in improving identification, treatment and follow up of hip fracture patients

Abstract

Introduction In an effort to improve the diagnosis and treatment rate in patients with fragility fractures, many health care organizations have implemented secondary prevention programs, widely known as fracture liaison service (FLS). At an academic medical center, a technology driven FLS was developed as a joint effort between the departments of Internal Medicine and Orthopedic Surgery and was launched in March 2016. Objective This abstract presents our early findings with a goal to evaluate the effects of a single institution FLS on education, diagnosis and treatment of patients who presented with hip fracture. Method The FLS model was designed to utilize the asset of a robust electronic medical record (Epic Systems, Madison, WI, USA) and develop a system within the EMR that is comprised of four key elements 1) improving patient education, 2) standardizing hip fracture admission order set, 3) post-discharge communication with rehabilitation facilities and 4) implementation of an outpatient evaluation for osteoporosis (OP) as part of routine health maintenance. A retrospective chart review was performed on 310 hip fracture patients admitted prior to the launch of FLS from 01/01/2010 to 12/31/2012 and subsequently a preliminary analysis has been done on 276 patients admitted from 3/27/2016 to 8/29/2017 after implementing FLS. In each group patient's age, gender, use of OP medications, use of vitamin D and calcium supplementation, bone mineral density (BMD) scan, and measurements of laboratory tests appropriate for evaluating bone disease were evaluated. Results The baseline demographic characteristics of the two groups, namely age and gender, did not significantly differ. Results were notable for significantly greater use of vitamin D/Ca in the post-FLS group. BMD testing did not significantly differ between groups. Use of OP medications was almost double in the post-FLS group compared with pre-FLS, but this was not statistically significant. The remainder of the data is shown in table 1. Conclusion Although FLS is in early stages, we have successfully been able to implement a standardized approach to hip fracture admission, which ensures obtaining relevant labs, improving patient education and post-hospitalization continuity of care. We have seen an increase in number of patients who were started on supplements and OP medications. Although treatment rate did not significantly differ from pre-FLS cohort, it likely is an underestimation due to short follow up of only a few months in large portion of the patients. As more data becomes available the efficacy of the existing structure can be more accurately evaluated and we can better determine whether a system managed through the EMR can function independent of a designated FLS coordinator.