Breaking the cycle of recurrent fracture: Scaling up a secondary fracture prevention program in Fraser Health to inform spread across British Columbia

Co-leads:

  • Sonia Singh
    Fraser Health
  • Larry Funnell
    Patient partner
  • Tania Bubela
    SFU
Executive sponsor:

  • Linda Dempster
    Fraser Health

Low-trauma fractures (which occur spontaneously or following minor trauma) are a frequent consequence of osteoporosis and can lead to significant disability, and even death, for patients. One low-trauma fracture often leads to a cycle of recurrent fracture. For example, approximately 50 percent of patients who suffer a hip fracture have a history of past fracture.

In BC, the annual cost for osteoporosis-related fractures has been estimated at $269 million for hospital care, Medical Services Plan and Pharmacare alone. Despite the availability of effective treatments that reduce future fracture risk by up to 50 percent, less than 20 percent of patients suffering low trauma fractures receive such treatments in their post-fracture care. This is the osteoporosis care gap.

The evidenced-based Fracture Liaison Services (FLS) model has been adopted worldwide as the most effective model for preventing recurrent osteoporosis-related fractures in a cost-effective manner. FLS involves a dedicated coordinator who captures the patient at the point of orthopedic care for the low-trauma fracture and integrates secondary fracture prevention into the overall fracture experience. FLS coordinators link fracture patients with community family physicians to ensure sustainability and follow-through of initiated interventions to prevent another fracture.

In 2012, the Secondary Fracture Prevention Research Team in Fraser Health (FH) brought together osteoporosis and fall prevention experts to develop an FLS model that fit the context of the BC health-care environment. In 2015, the model was implemented at Peace Arch Hospital (PAH).

A controlled before and after study demonstrated a three-fold increase in appropriate fracture prevention interventions taken up by low-trauma fracture patients in the FLS group compared with a control group. FLS is now a permanent program at PAH. In this project, the team will explore how the FLS model implemented at one hospital can be successfully adapted and scaled-up to other hospital sites within FH.

Consolidated Framework for Implementation Research (CFIR) 16 will inform the team’s implementation strategy and the RE-AIM 17 model will frame the process and outcome evaluation. The key outcome is to inform an FLS implementation strategy that can be used to spread the FLS model across BC, thereby improving patients’ quality of life after low-trauma fractures and decreasing health care costs related to recurrent fracture.

Breaking the cycle of recurrent fracture: Scaling up a fracture prevention program in British Columbia

Co-leads:

  • Sonia Singh
    Fraser Health
  • Larry Funnell
    Patient partner
  • Tania Bubela
    SFU
Executive sponsor:

  • Teresa O’Callaghan
    Fraser Health

Low-trauma fractures (fractures that occur spontaneously or following minor trauma) are a frequent consequence of osteoporosis, leading to significant disability and even death for patients.

One low-trauma fracture often leads to a cycle of recurrent fracture. For example, half of patients who suffer a hip fracture have a history of past fracture. In BC, the cost for osteoporosis-related fractures has been estimated at $269 million for hospitals, the medical services plan, and Pharmacare alone.

Despite the availability of effective treatments that reduce future fracture risk by up to 50%, fewer than 20% of patients suffering low trauma fractures receive such treatments in their post-fracture care. This is the osteoporosis care gap.

The evidenced-based Fracture Liaison Services (FLS) model has been recognized and adopted worldwide as the most effective model for preventing recurrent osteoporosis-related fractures in a cost-effective manner. FLS involves a dedicated coordinator who “captures” the patient at the point of orthopedic care for the low-trauma fracture and seamlessly integrates secondary fracture prevention into the overall fracture experience. FLS coordinators link up with community family physicians to ensure sustainability and follow-through of the initiated interventions to prevent further fractures.

In 2012, the Secondary Fracture Prevention Research Team at Fraser Health brought together osteoporosis and fall prevention experts locally, nationally and internationally, to develop an FLS model that fit the context of the BC health care environment. In 2014, the model was implemented at Peace Arch Hospital (PAH) in BC. A controlled before and after study demonstrated a three-fold increase in appropriate fracture prevention interventions received by low trauma fracture patients in the FLS group compared to a control group. FLS is now a permanent program at PAH.

This project will explore how the FLS model implemented at one hospital in BC can be successfully adapted and scaled-up to other hospital sites within BC. The Consolidated Framework for Implementation Research will inform the implementation strategy and the RE-AIM model will frame the process and outcome evaluation. The key outcome will be to inform an FLS implementation strategy that can be used to scale up to other hospital sites across BC, improving patient quality of life after low trauma fractures and decreasing health care costs related to recurrent fractures.

Why are so many patients dissatisfied with knee replacement surgery? Exploring variations of the patient experience

The purpose of this research is to determine why such high numbers of patients – up to 1 in 5 – who undergo knee replacement surgery are dissatisfied with the outcomes of their surgery. Total Knee Arthroplasty (TKA), is the most requested joint replacement surgery in Canada, and will continue to increase in response to the needs of an aging population.   A greater understanding of the variations in patient outcomes, and the factors that contribute to the dissatisfaction rate, will inform surgical program planning and help to standardize procedures and services to achieve better outcomes.

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