Background/Purpose:  There is an ongoing effort worldwide to effect quality improvement to address secondary prevention of fractures. Patients who have incurred fractures attributed to osteoporosis have low rates of diagnostic screening and treatment for osteoporosis. An LLUMC Osteoporosis Clinical Working Group spearheaded by the divisions/departments of Rheumatology, Endocrinology, Orthopedics and Geriatrics was established February 2016, with one of the main arms being the Fracture Liaison Service. We determined the most common problems related to primary and secondary prevention, and management. We reviewed the most recent volumes of fractures seen in the hospital through the electronic medical record (EMR).

Methods: A consensus meeting between collaborating specialties was held to discuss system-based practice challenges in managing osteoporosis issues. An October 2015-April 2016 EMR review by our Patient Safety and Reliability Office was done utilizing International Statistical Classification of Diseases and Related Health Problems version 10 (ICD-10) codes to determine: 1) numbers of fracture patients seen at emergency room and/or hospital, 2) hospital stay length, 3) anatomic sites, and 4) procedural interventions done.

Results:  The needs identified in our healthcare system are: 1) improving education of patients about the need to diagnose and treat osteoporosis; 2) improving access to healthcare providers committed to addressing osteoporosis and improving rates of screening and compliance with therapy among patients; 3) improving accessibility to DXA results. A High-Risk Osteoporosis (HRO) line of service generating consults for both inpatient and outpatient services, including interdisciplinary providers, is in progress. FLS certification was obtained by a rheumatologist. Four target groups identified are: 1) Patients who have sustained fractures, 2) Men with osteoporosis, 3) Postmenopausal women needing screening and 4) Patients on steroids. Steps to address solutions include: EMR coordination to optimize consult generation and DXA access, partnership development with Physical Therapy, Emergency Medicine, Hospitalist Medicine, General Medicine, Pulmonology, Ophthalmology, Obstetrics and Family Medicine. EMR review revealed 261 fracture encounters; 136 (52%) encounters for femoral fractures (134 initial, 2 subsequent), and 32 (12.3%) vertebral fracture encounters (31 initial and 1 subsequent). Six vertebral fracture encounters were coded as “age related osteoporosis”. Eight encounters were linked to steroid use codes (4 femur, 2 vertebral, 1 radius and tibia each). Most common length of hospital stay was 3 days (62 encounters; range 1-20 days).

Conclusion:  A large number of patients with fractures presented to LLUMC within a seven month period. Interdisciplinary coordination to address specific patient groups with or prone to osteoporosis have been developed. Tracking of outcomes to this initial effort includes improving bone density screening rates, education of patients, and compliance with therapy. Improving ICD10 coding by providers can help facilitate tracking of outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/interdisciplinary-osteoporosis-clinical-working-group-and-fracture-liaison-service-at-loma-linda-university-medical-center-llumc-laying-the-groundwork/