Background/Purpose: Fragility fractures (FF) are a sentinel event in osteoporosis and world-wide only 20% of patients with a FF receive treatment, a large care gap. A 2016-2017 study done at a university-based academic medical center (AMC) found up to 90% of patients admitted for FF did not receive treatment after discharge. A Fracture Liaison Service (FLS) has subsequently been implemented at AMC. The same rheumatologists serve AMC and 20 miles away, Academic Medical Center 2 (AMC2). The objective of this study is to determine the quality of care received by AMC2 FF patients and determine the health disparities among patients seen in these two health systems.

Methods: Medical records of patients with FF who were at least 50 years of age who presented to AMC2 between July 2017 and June 2018 were reviewed. Those with ICD10 codes for FF were reviewed for dual x-ray absorptiometry (DXA) utilization, pharmacotherapy initiation, adequate calcium and vitamin D supplementation.  Patient ethnicity and access to AMC2 vs. out of system primary care were also noted.

The objective of this study is to determine factors contributing to gaps in patient care in the AMC2 system with the goal of informing health improvement efforts as part of a  Plan-Do-Study-Act (PDSA) cycle. An outcomes comparison between the two medical centers was subsequently done, directed toward socioeconomic status and access to care.

Results: 144 AMC2 patient charts were analyzed. 120 (83%) were female. 36.8% of encounter cases at AMC2 involved Hispanic or Latino patients who were Hispanic or Latino, similar to the ethnicity profile at AMC. 83 (58%) had femoral neck fractures, 13 (9%) had vertebral fractures. 3.47% were subsequently seen at outpatient AMC2 primary care clinics within 6 months post-hospital discharge, 2.96% of which had a post-fracture DXA scan. Similarly, 5% of patients at AMC had a post-fracture DXA completed.

2.78% of AMC2 patients with previous FF were on pharmacologic therapy prior to their ED encounter, vs. 14.4% of AMC patients with prior FF. Though very few patients seen at AMC2 were on treatment for osteoporosis, previous fracture rates were similar: 23% of patients at AMC and 20% at AMC2.  At AMC2, 4.1% had osteoporosis treatment after discharge, which was lower than the 10.3% of patients at AMC who were given pharmacotherapy post-fracture. At AMC, 20.8% received calcium and 31.25% received vitamin D supplement after discharge. Comparatively, 12% of patients at AMC2 were given calcium and 21% were given vitamin D. (Table 1)

Conclusion: A minority of patients with FF presenting to AMC2 for FF are receiving optimal care post-hospital discharge. Between AMC and AMC 2, the post-fracture treatment rates were disproportionate among FF patients. Similarities in ethnicity remove this as an explanation of disparities in treatment rates. A limitation of this study is the inability to analyze data for patients who leave the AMC2 system post discharge. An FLS would be a good way to improve care and awareness among physicians and patients alike, but the inadequacies of healthcare access will most likely continue to hamper improvement efforts.

Table 1 RUHS

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/osteoporosis-management-outcomes-in-a-southern-california-county-health-system/