title: Improvement in osteoporosis detection in a fracture liaison service with integration of a geriatric hip fracture care program.
abstract: BACKGROUND
  Care gaps have been identified in the treatment of osteoporosis after the occurrence of a fragility hip fracture. HiROC (High Risk Osteoporosis Clinic) is a fracture liaison service implemented at our institution. In ProvenCare geriatric hip fracture care program at our institution pre-set orders for the inpatient HiROC consults were prescribed. We hypothesized that there will be a significant increase in the rate of enrollment of patients in the HiROC program after the integration of the pre-set orders.
  
  
  METHODS
  The trauma database at a level-I trauma center was reviewed retrospectively for the charts of patients >50 years of age with fragility intertrochanteric fractures. Patients not treated under the geriatric hip fracture care program and patients treated under the geriatric hip fracture care program were identified and reviewed for the enrollment in HiROC and subsequent follow up.
  
  
  RESULTS
  Out of 589 patients treated before the implementation of ProvenCare, 443 patients (75%) were enrolled in HiROC at the index consult. In comparison, out of 153 patients treated after the implementation of ProvenCare, 131 patients (85.6%) were enrolled in HiROC at the index consult. The difference between the two groups was statistically significant (p=0.008).
  
  
  CONCLUSIONS
  Our experience shows that the occurrence of a fragility intertrochanteric fracture can be effectively utilized for the detection and initiation of treatment of osteoporosis. With the implementation of pre-set orders in the geriatric hip fracture care program significantly better enrollment can be achieved.
authors: Department of Orthopaedic Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA 17822-2130, USA.
authors: Amrut
authors: A
authors: Borade
authors: Department of Orthopaedic Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA 17822-2130, USA.
authors: Harish
authors: H
authors: Kempegowda
authors: Department of Orthopaedic Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA 17822-2130, USA.
authors: Akhil
authors: A
authors: Tawari
authors: Department of Orthopaedic Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA 17822-2130, USA.
authors: Michael
authors: M
authors: Suk
authors: Department of Orthopaedic Surgery, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA 17822-2130, USA. Electronic address: dshorwitz@geisinger.edu.
authors: Daniel S
authors: DS
authors: Horwitz
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006299:Health Services for the Aged / Q000458:organization & administration; D006620:Hip Fractures / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000175:diagnosis* / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control*; D010384:Pelvic Bones / Q000473:pathology*; D015397:Program Evaluation; D058996:Quality Improvement; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D014193:Trauma Centers; D014481:United States / Q000453:epidemiology
keywords: Care gap; Enrollment; Fracture liaison service; Osteoporosis; Pre-set