A Collaborative Approach to Bone Health

IF 1.7 4区 医学 Q4 ENDOCRINOLOGY & METABOLISM
SHIBI A. Kunjumon (Primary Author)
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引用次数: 0

Abstract

Purpose/Aims

Background: Osteoporosis is a global problem; people living with osteoporosis have increased dramatically in the last few decades due to the aging population and changes in lifestyle. The project aims to improve post-fracture care and use a preventative service for compromised bone quality patients in the Emergency Room (ER). The QI project aims to increase ER providers' awareness about osteoporosis and to refer appropriately to Bone Health Clinic (BHC) to prevent future fractures.

Rationale/Background

Methods: Most fractures are first treated in the ER, making ER the gateway for treating fractures. A fragility fracture (FF) care pathway was developed to help providers to identify patients at risk for osteoporosis and guide the providers in placing appropriate referrals to BHC. Educational sessions for providers, FF care pathway posters, and modified EPIC discharge smart phrases for fracture patients that prompted the ER providers to add Bone Health recommendations while discharging the FF patients were developed as part of the framework. The number of new fragility fracture patients, including spine fractures, wrist, humerus, and ankle fractures seen in ER with appropriate BH recommendations, ultimately determined the project's success.

Brief Description of the Undertaking/Best Practice

The Plan-Do-Study-Act (PDSA) model created a process change and improved patient outcomes. The conceptual framework helped to implement the proposed change, ensured leadership and management support, and established the feedback process to sustain the implemented change. Post-fracture care process improvement enabled ER physicians to recommend patients to BHC to ensure appropriate osteoporosis management, resulting in improved care from 2% to 66% of patients with fragility fractures.

Outcomes achieved/documented

The outcome measure of the intervention is the percentage of bone health recommendations made by ER providers for fragility fracture patients. The ICD code with fragility fracture patients analyzed in ER data found that 0% to 25% percent of patients were recommended to the BHC through ER providers after the intervention. The process measures report the validity of the intervention and tracked 30% of ER providers who attended the educational session; 10% to 20% of ER providers adhered to the fragility fracture pathway recommendations. Ten percent of patients accepted the BHC referrals. In contrast, 10% of patients were admitted as in-patients after surgery, and 5% of patients were discharged to skilled nursing facilities or hospice for further care without accepting the bone health referrals. Balancing measures increase patient waiting time for BHC appointments to see the provider, estimated three to four weeks from discharge. The conceptual framework emphasizes sustaining improvements; thus, upon QI completion, weekly reports will be transitioned to monthly for review and will be evaluated at quarterly multidisciplinary meetings for compliance and fiscal reports.

Conclusions

The need for this project came from my clinical experience seeing patients who suffered frequent subsequent fractures because of the failure to identify the patient as a high risk for secondary fractures and not utilizing proper preventative care. The project identified the clinical problems and reinforced Evidence-Based Practice (EBP) in FF patients related to osteoporosis to close treatment gap interventions. The project offered an opportunity to promote positive change in the post-fracture care program with collaboration and coordination with providers by recognizing at-risk patients to reduce future fractures.

骨骼健康的合作方法
目的/目的背景:骨质疏松症是一个全球性问题;在过去的几十年里,由于人口老龄化和生活方式的改变,骨质疏松症患者急剧增加。该项目旨在改善骨折后护理,并在急诊室(ER)为骨骼质量受损的患者提供预防性服务。QI项目旨在提高急诊医生对骨质疏松症的认识,并适当地转介到骨骼健康诊所(BHC),以预防未来的骨折。理由/背景方法:大多数骨折首先在急诊室治疗,使急诊室成为治疗骨折的门户。脆性骨折(FF)护理路径的开发,以帮助供应商识别患者骨质疏松症的风险,并指导供应商在适当的转诊到BHC。作为框架的一部分,为医疗服务提供者提供教育课程、FF护理路径海报,以及为骨折患者修改的EPIC出院智能短语,这些都促使急诊服务提供者在FF患者出院时增加骨骼健康建议。急诊中出现的新发脆性骨折患者(包括脊柱骨折、手腕骨折、肱骨骨折和踝关节骨折)的数量最终决定了项目的成功。计划-执行-研究-行动(PDSA)模式改变了流程,改善了患者的治疗效果。概念框架有助于实施提议的变革,确保领导和管理的支持,并建立反馈过程以维持实施的变革。骨折后护理流程的改进使急诊医生能够向BHC推荐患者,以确保适当的骨质疏松症治疗,从而使脆性骨折患者的护理从2%提高到66%。达到/记录的结果干预措施的结果测量是急诊医生为脆性骨折患者提出的骨骼健康建议的百分比。急诊数据中分析的脆性骨折患者的ICD代码发现,在干预后,0%至25%的患者通过急诊提供者推荐给BHC。过程测量报告了干预的有效性,并跟踪了参加教育会议的30%的急诊室提供者;10% - 20%的急诊医生遵循脆性骨折路径的建议。10%的病人接受了BHC的转诊。相比之下,10%的患者在手术后作为住院患者入院,5%的患者出院到专业护理机构或临终关怀医院接受进一步护理,而没有接受骨骼健康转诊。平衡措施增加了病人等待BHC预约看提供者的时间,估计从出院后三到四周。概念框架强调持续改进;因此,在QI完成后,每周报告将转为每月审查,并将在季度多学科会议上对合规性和财务报告进行评估。这个项目的必要性来自于我的临床经验,我看到一些患者由于未能识别出他们是继发性骨折的高风险患者,也没有采取适当的预防措施,而经常发生骨折。该项目确定了与骨质疏松相关的FF患者的临床问题,并加强了循证实践(EBP),以缩小治疗差距干预措施。该项目提供了一个机会,通过与供应商的合作和协调,通过识别高危患者来减少未来的骨折,促进骨折后护理项目的积极变化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Clinical Densitometry
Journal of Clinical Densitometry 医学-内分泌学与代谢
CiteScore
4.90
自引率
8.00%
发文量
92
审稿时长
90 days
期刊介绍: The Journal is committed to serving ISCD''s mission - the education of heterogenous physician specialties and technologists who are involved in the clinical assessment of skeletal health. The focus of JCD is bone mass measurement, including epidemiology of bone mass, how drugs and diseases alter bone mass, new techniques and quality assurance in bone mass imaging technologies, and bone mass health/economics. Combining high quality research and review articles with sound, practice-oriented advice, JCD meets the diverse diagnostic and management needs of radiologists, endocrinologists, nephrologists, rheumatologists, gynecologists, family physicians, internists, and technologists whose patients require diagnostic clinical densitometry for therapeutic management.
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