Assessment of inpatient fragility fracture education and outpatient follow-up at an urban tertiary care institution.
OBJECTIVE
To assess the impact of inpatient fragility fracture education on follow-up care at an urban tertiary care center with a multidisciplinary inpatient education and follow-up initiative.


METHODS
Participants included 139 patients with low energy fragility fractures who were identified, educated, and referred for follow-up by a coordinator. Education consisted of an initial 30 to 40-minute session with the patient and family followed by 10-minute sessions on subsequent hospitalization days. Follow-up activities with primary care physicians (PCPs) and orthopaedic surgeons were documented.


RESULTS
Of the 129 patients still living at the end of the study period, 74 (57%) had followed up with their PCP while 93 (72%) had returned to see their orthopaedic surgeons. Women were 2.7 times more likely than men to address the cause of the fragility fracture (95% confidence interval [CI], 1.13-6.97; P = .038) and were 6.18 times more likely to receive treatment or to have bone mineral density (BMD) testing (95% CI, 1.29-29.61; P = .023). Patients previously treated for osteoporosis were 3 times more likely to follow-up with their PCPs (95% CI, 1.10-8.02; P = .02), while patients who had previous BMD tests were 4.9 times more likely to follow-up (95% CI, 1.89-12.79; P = .001). We observed a 42% reduction in the likelihood of seeing a physician for osteoporosis evaluation for each additional 10 years of age (95% CI, 13%-61% reduction in odds; P = .008).


CONCLUSIONS
In the urban setting, follow-up rates are not sufficiently improved by inpatient education. Improved, persistent communication between the orthopaedic surgeon, PCP, and patient is needed to effectively treat patients and prevent future fractures.
Yoon
Richard S
RS
Department of Orthopaedic Surgery, Columbia University, New York 10032, USA.
Macaulay
William
W
Torres
Gail
G
Nellans
Kate W
KW
Siris
Ethel S
ES
Bigliani
Louis U
LU
Becker
Carolyn
C
D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy*; D006620:Hip Fractures / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D006786:Hospitals, Urban; D006801:Humans; D007297:Inpatients / Q000193:education*; D008297:Male; D009985:Orthopedics / Q000193:education; D010024:Osteoporosis / Q000150:complications / Q000628:therapy; D010045:Outpatients; D010351:Patient Discharge; D010353:Patient Education as Topic; D010821:Physicians, Family