A team approach: implementing a model of care for preventing osteoporosis related fractures.
The implementation of a multidisciplinary team-based model of care has led to significant increases in identification of patients with osteoporosis who are at risk of refracture, together with improved treatment uptake and ongoing management.


BACKGROUND
Osteoporosis-related fractures and consequent hospital admissions are largely preventable; however, little attention has been paid to how to achieve this, in particular, through improved models of care. Presentation to emergency departments (ED) with minimal trauma fracture (MTF) provides opportunity for patients at risk to be identified, referred and managed through a systematic process ensuring prompt intervention and continuing follow-up. This study is aimed to design and implement a care model for people over 50 years of age, presenting to ED with an MTF.


METHODS
Established a multidisciplinary fracture prevention team to identify and capture at-risk patients for referral and management. Clinical data revealed the extent of lost opportunities. An electronic flagging system and data acquisition tool were developed and piloted. Established a referral pathway to detect, manage and follow-up patients, coordinated by a fracture prevention nurse.


RESULTS
Increased awareness of osteoporosis as a cause of MTF, better identification of at-risk patients across departments and services and development of a flagging and referral protocol has resulted in 100% capture of at-risk patients presented to ED. As a result there has been a significant increase in patients attending the fracture prevention clinic (FPC) (p < 0.001) from 11% in 2007 to 29% in 2008 and a significantly reduced time between fracture and when patients are seen in the FPC (p < 0.001).


CONCLUSIONS
A multipronged systematic team approach to identifying and capturing patients with a high risk of refracture and a dedicated nurse coordinator role has created efficiencies in the detection and management of osteoporosis.
Level 3, John Hunter Hospital, Hunter New England Area Health Service, Locked Bag 1, Hunter Region Mail Centre (HRMC), Newcastle, NSW, 2310, Australia. michelle.giles@hnehealth.nsw.gov.au
M
M
Giles
J
J
Van Der Kallen
V
V
Parker
K
K
Cooper
K
K
Gill
L
L
Ross
S
S
McNeill
D000368:Aged; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009517:New South Wales / Q000453:epidemiology; D010024:Osteoporosis / Q000175:diagnosis / Q000628:therapy; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration; D012621:Seasons; D055502:Secondary Prevention