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Naranjo A, Ojeda S, Giner M, Balcells-Oliver M, Canals L, Cancio JM, Duaso E, Mora-Fernández J, Pablos C, González A, Lladó B, Olmo FJ, Montoya MJ, Menéndez A, Prieto-Alhambra D. Best Practice Framework of Fracture Liaison Services in Spain and their coordination with Primary Care. Arch Osteoporos 2020; 15:63. [PMID: 32335759 PMCID: PMC7183494 DOI: 10.1007/s11657-020-0693-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/22/2020] [Indexed: 02/03/2023]
Abstract
The coordination of Fracture Liaison Services (FLS) with Primary Care (PC) is necessary for the continuity of care of patients with fragility fractures. This study proposes a Best Practice Framework (BPF) and performance indicators for the implementation and follow-up of FLS-PC coordination in clinical practice in Spain. PURPOSE To develop a BPF for the coordination of FLS with PC in Spain and to improve the continuity of care for patients with fragility fractures. METHODS A Steering Committee selected experts from seven Spanish FLS and related PC doctors and nurses to participate in a best practice workshop. Selection criteria were an active FLS with an identified champion and prior contact with PC centres linked to the hospital. The main aim of the workshop was to review current FLS practices in Spain and their integration with PC. A BPF document with processes, tools, roles, and metrics was then generated. RESULTS Spanish FLS consists of a multidisciplinary team of physicians/nurses but with low participation of other professionals and PC staff. Evaluation and treatment strategies are widely variable. Four desired standards were agreed upon: (1) Effective channels for FLS-PC communication; (2) minimum contents of an FLS clinical report and its delivery to PC; (3) adherence monitoring 3 months after FLS baseline visit; and (4) follow-up by PC. Proposed key performance indicators are (a) number of FLS-PC communications, including consensus protocols; (b) confirmation FLS report received by PC; (c) medical/nursing PC appointment after FLS report received; and (d) number of training sessions in PC. CONCLUSIONS The BPF provides a comprehensive approach for FLS-PC coordination in Spain, to promote the continuity of care in patients with fragility fractures and improve secondary prevention. The implementation of BPF recommendations and performance indicator tracking will benchmark best FLS practices in the future.
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Affiliation(s)
- A Naranjo
- Department of Rheumatology, Doctor Negrin University Hospital, Las Palmas de Gran Canaria, Spain.
| | - S Ojeda
- Department of Rheumatology, Doctor Negrin University Hospital, Las Palmas de Gran Canaria, Spain
| | - M Giner
- Bone Metabolism Unit, Department of Internal Medicine, "Virgen Macarena" University Hospital, Seville, Spain
| | | | | | - J M Cancio
- Geriatrics Service, Centre Sociosanitari El Carme, Badalona Serveis Assistencials (BSA), Barcelona, Spain
| | - E Duaso
- Geriatrics Service, Igualada Hospital, Barcelona, Spain
| | - J Mora-Fernández
- Geriatrics Service, Coordinator FLS Hospital Clínico San Carlos, Madrid, Spain
| | - C Pablos
- Geriatrics Service, Complejo Asistencial Universitario Salamanca, Salamanca, Spain
| | - A González
- Geriatrics Service, Complejo Asistencial Universitario Salamanca, Salamanca, Spain
| | - B Lladó
- Fracture Liaison Service, Hospital Son Llatzer, Mallorca, Spain
| | - F J Olmo
- Fracture Liaison Service, "Virgen Macarena" University Hospital, Seville, Spain
| | - M J Montoya
- Fracture Liaison Service, "Virgen Macarena" University Hospital, Seville, Spain
| | - A Menéndez
- Fracture Liaison Service, Hospital Vital Álvarez-Buylla, Asturias, Spain
| | - D Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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Chang LY, Tsai KS, Peng JK, Chen CH, Lin GT, Lin CH, Tu ST, Mao IC, Gau YL, Liu HC, Niu CC, Hsieh MH, Chien JT, Hung WC, Yang RS, Wu CH, Chan DC. The development of Taiwan Fracture Liaison Service network. Osteoporos Sarcopenia 2018; 4:47-52. [PMID: 30775542 PMCID: PMC6362955 DOI: 10.1016/j.afos.2018.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/11/2018] [Accepted: 06/03/2018] [Indexed: 11/29/2022] Open
Abstract
Osteoporosis and its associated fragility fractures are becoming a severe burden in the healthcare system globally. In the Asian-Pacific (AP) region, the rapidly increasing in aging population is the main reason accounting for the burden. Moreover, the paucity of quality care for osteoporosis continues to be an ongoing challenge. The Fracture Liaison Service (FLS) is a program promoted by International Osteoporosis Foundation (IOF) with a goal to improve quality of postfracture care and prevention of secondary fractures. In this review article, we would like to introduce the Taiwan FLS network. The first 2 programs were initiated in 2014 at the National Taiwan University Hospital and its affiliated Bei-Hu branch. Since then, the Taiwan FLS program has continued to grow exponentially. Through FLS workshops promoted by the Taiwanese Osteoporosis Association (TOA), program mentors have been able to share their valuable knowledge and clinical experience in order to promote establishments of additional programs. With 22 FLS sites including 11 successfully accredited on the best practice map, Taiwan remains as one of the highest FLS coverage countries in the AP region, and was also granted the IOF Best Secondary Fracture Prevention Promotion award in 2017. Despite challenges faced by the TOA, we strive to promote more FLS sites in Taiwan with a main goal of ameliorating further health burden in managing osteoporotic patients.
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Affiliation(s)
- Lo-Yu Chang
- School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Keh-Sung Tsai
- Superintendent Office, Far Eastern Polyclinic of Far Eastern Medical Foundation, Taipei, Taiwan
| | - Jen-Kuei Peng
- Department of Family Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
| | - Chung-Hwan Chen
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Gau-Tyan Lin
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chin-Hsueh Lin
- Department of Geriatric Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Te Tu
- Department of Endocrinology and Metabolism, Changhua Christian Hospital, Changhua City, Taiwan
| | - I-Chieh Mao
- Department of Endocrinology and Metabolism, Changhua Christian Hospital, Changhua City, Taiwan
| | - Yih-Lan Gau
- Department of Orthopaedics, Taitung Christian Hospital, Taitung City, Taiwan
| | - Hsusan-Chih Liu
- Department of Orthopaedics, Taitung Christian Hospital, Taitung City, Taiwan
| | - Chi-Chien Niu
- Department of Orthopaedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Min-Hong Hsieh
- Department of Orthopaedics, Dalin Tzu Chi Hospital, Chiayi County, Taiwan
| | - Jui-Teng Chien
- Department of Orthopaedics, Dalin Tzu Chi Hospital, Chiayi County, Taiwan
| | - Wei-Chieh Hung
- Department of Family Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Rong-Sen Yang
- Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hsing Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ding-Cheng Chan
- Superintendent Office, National Taiwan University Hospital Chu-Tung Branch, Hsinchu County, Taiwan
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Javaid MK, Kyer C, Mitchell PJ, Chana J, Moss C, Edwards MH, McLellan AR, Stenmark J, Pierroz DD, Schneider MC, Kanis JA, Akesson K, Cooper C. Effective secondary fracture prevention: implementation of a global benchmarking of clinical quality using the IOF Capture the Fracture® Best Practice Framework tool. Osteoporos Int 2015; 26:2573-8. [PMID: 26070301 DOI: 10.1007/s00198-015-3192-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/27/2015] [Indexed: 12/20/2022]
Abstract
UNLABELLED Fracture Liaison Services are the best model to prevent secondary fractures. The International Osteoporosis Foundation developed a Best Practice Framework to provide a quality benchmark. After a year of implementation, we confirmed that a single framework with set criteria is able to benchmark services across healthcare systems worldwide. INTRODUCTION Despite evidence for the clinical effectiveness of secondary fracture prevention, translation in the real-world setting remains disappointing. Where implemented, a wide variety of service models are used to deliver effective secondary fracture prevention. To support use of effective models of care across the globe, the International Osteoporosis Foundation's Capture the Fracture® programme developed a Best Practice Framework (BPF) tool of criteria and standards to provide a quality benchmark. We now report findings after the first 12 months of implementation. METHODS A questionnaire for the BPF was created and made available to institutions on the Capture the Fracture website. Responses from institutions were used to assign gold, silver, bronze or black (insufficient) level of achievements mapped across five domains. Through an interactive process with the institution, a final score was determined and published on the Capture the Fracture website Fracture Liaison Service (FLS) map. RESULTS Sixty hospitals across six continents submitted their questionnaires. The hospitals served populations from 20,000 to 15 million and were a mix of private and publicly funded. Each FLS managed 146 to 6200 fragility fracture patients per year with a total of 55,160 patients across all sites. Overall, 27 hospitals scored gold, 23 silver and 10 bronze. The pathway for the hip fracture patients had the highest proportion of gold grading while vertebral fracture the lowest. CONCLUSION In the first 12 months, we have successfully tested the BPF tool in a range of health settings across the globe. Initial findings confirm a significant heterogeneity in service provision and highlight the importance of a global approach to ensure high quality secondary fracture prevention services.
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Affiliation(s)
- M K Javaid
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, University of Oxford, Oxford, UK
| | - C Kyer
- International Osteoporosis Foundation (IOF), Nyon, Switzerland
| | - P J Mitchell
- Synthesis Medical NZ Ltd, Auckland, New Zealand
- University of Notre Dame Australia, Sydney, Australia
| | - J Chana
- Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
| | - C Moss
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - M H Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | | | - J Stenmark
- International Osteoporosis Foundation (IOF), Nyon, Switzerland
| | - D D Pierroz
- International Osteoporosis Foundation (IOF), Nyon, Switzerland
| | - M C Schneider
- International Osteoporosis Foundation (IOF), Nyon, Switzerland
| | - J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - K Akesson
- Department of Orthopaedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - C Cooper
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, University of Oxford, Oxford, UK.
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
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