title: Describing variation in the delivery of secondary fracture prevention after hip fracture: an overview of 11 hospitals within one regional area in England.
abstract: CONCLUSIONS
  There is variation in how services to prevent second fractures after hip fracture are organised. We explored this in more detail at 11 hospitals. Results showed that there was unwarranted variation across a number of aspects of care. This information can be used to inform service delivery in the future.
  
  
  BACKGROUND
  Hip fractures are usually the result of low impact falls and underlying osteoporosis. Since the risk of further fractures in osteoporotic patients can be reduced by between 20 and 70 % with bone protection therapy, the NHS is under an obligation to provide effective fracture prevention services for hip fracture patients to reduce risk of further fractures. Evidence suggests there is variation in service organisation. The objective of the study was to explore this variation in more detail by looking at the services provided in one region in England.
  
  
  METHODS
  A questionnaire was designed which included questions around staffing, models of care and how the four components of fracture prevention (case finding, osteoporosis assessment, treatment initiation and adherence (monitoring) were undertaken. We also examined falls prevention services. Clinicians involved in the delivery of osteoporosis services at 11 hospitals in one region in England completed the questionnaire.
  
  
  RESULTS
  The service overview showed significant variation in service organisation across all aspects of care examined. All sites provided some form of case finding and assessment. However, interesting differences arose when we examined how these components were structured. Eight sites generally initiated treatment in an inpatient setting, two in outpatients and one in primary care. Monitoring was undertaken by secondary care at seven sites and the remainder conducted by GPs.
  
  
  CONCLUSIONS
  The variability in service provision was not explained by local variations in care need. Further work is now needed to establish how the variability in service provision affects key patient, clinical and health economic outcomes.
authors: Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK.
authors: S
authors: S
authors: Drew
authors: S
authors: S
authors: Sheard
authors: J
authors: J
authors: Chana
authors: C
authors: C
authors: Cooper
authors: M K
authors: MK
authors: Javaid
authors: A
authors: A
authors: Judge
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D003695:Delivery of Health Care / Q000458:organization & administration*; D004739:England / Q000453:epidemiology; D006620:Hip Fractures / Q000453:epidemiology / Q000517:prevention & control*; D006739:Hospital Administration; D006801:Humans; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control*; D010348:Patient Care Team / Q000458:organization & administration; D011364:Professional Practice / Q000706:statistics & numerical data; D012008:Recurrence; D055502:Secondary Prevention / Q000458:organization & administration*; D013222:State Medicine / Q000458:organization & administration; D016903:Drug Monitoring
chemical_list: D050071:Bone Density Conservation Agents