capture the fracture: overview a global campaign for the secondary prevention of fractures by...
TRANSCRIPT
Capture the Fracture: Overview
A global campaign for the secondary prevention of
fractures by facilitating the implementation of
Fracture Liaison Services (FLS)
Professor Cyrus Cooper, MA, DM, FRCP, FFPH, FMedSciDirector & Professor of Rheumatology, MRC Lifecourse Epidemiology Unit; Vice Dean, Faculty of Medicine, University of Southampton; and Professor of Musculoskeletal Science, University of Oxford.
Acknowledgements
Capture the Fracture Steering Committee:•Prof Kristina Åkesson, Chair Capture the Fracture, Skåne University Hospital SWE•Prof Cyrus Cooper, Chair IOF Committee of Scientific Advisors, MRC Lifecourse Epidemiology Unit, University of Southampton & University of Oxford UK•Dr Alastair McLellan, Gardiner Institute Western Infirmary UK •Paul Mitchell, Synthesis Medical Limited NZL•Dr Kassim Javaid, University of Oxford UK•Judy Stenmark, Chief Executive Officer, IOF•Dr Dominique Pierroz, Science Manager, IOF•Carey Kyer, Capture the Fracture Coordinator, IOF•Dr Muriel Schneider, Capture the Fracture Coordinator, IOF
With additional support from•Charlotte Moss, MRC Lifecourse Epidemiology Unit, University of Southampton UK
Capture the Fracture
• The need for secondary fracture prevention • The Capture the Fracture campaign• How to get involved• Initial results
Effectiveness of secondary fracture prevention
Adapted from Brankin E, et al. Curr Med Res Opin 2005;21:4:475-482
Post-menopausal women 11.1 million
0.2 million
Post-menopausal women with newfracture each year
3.4 million
Post-menopausal women with osteoporosis
1.8 million
Post-menopausal women with priorfracture history
50% of hip fractures from
16% of the population
50% of hip fractures from
84% of the population
Amongst post-menopausal women, the majority of the population have not suffered fragility fractures. Case-finding strategies prioritising assessment of women with prior
fracture could identify 50% of potential hip fracture cases from 16% of the population
Amongst post-menopausal women, the majority of the population have not suffered fragility fractures. Case-finding strategies prioritising assessment of women with prior fracture could identify 50% of potential hip fracture cases from 16% of the population
• Systematic review of the literature (48 studies)
• Programmes used in clinical settings to facilitate guideline-based osteoporosis care following a fragility fracture
• Key components:• Dedicated coordinator• BMD provision• Physician and patient education• Patient follow-up within programme• Implementation audit• Economic analysis
Coordinator-based systems for secondary prevention of fragility fracture
A Report of the IOF CSA Fracture Working Group
Marsh D et al Osteop Int 2011; 22: 2051-65
Campaign structure to facilitate the implementation of Fracture Liaison Services (FLS)
• Best Practice Framework • Best Practice Recognition/application • Showcase of Best Practices/map
• Mentorship programme• Implementation guides & toolkits• Facilitated grant support
• Website www.capturethefracture.org• Resources• Communication/marketing • Coalition of partners
Set StandardsSet Standards
Facilitate Change
Facilitate Change
Create Awareness
Create Awareness
Main Programme
Purpose of the Best Practice Framework
13 internationally recognized & endorsed standards of care for secondary fracture prevention
1.Set the standard for FLS2.Assign quality level3.Benchmarking of global
service delivery
Standard Level 1 Level 2 Level 31.Patient Identification
Patients ID’d, not tracked
Patients ID’d, are tracked
Patients ID’d, tracked &Independent review
2.Patient Evaluation 50% assessed 70% assessed 90% assessed
3.Post Fracture Assessment Timing
Within 13-16 weeks Within 9-12 weeks Within 8 weeks
4.Vertebral Fracture (VF)
Known VF assessed Routinely assesses for VF
Radiologists identify VF
5.Assessment Guidelines
Local Regional National
6.Secondary Causes 50% of patients screened
70% of patients screened
90% of patients screened
7.Fall Prevention Services
50% of patients evaluated
70% of patients evaluated
90% of patients evaluated
8.Multifaceted assessment
50% of patients screened
70% of patients screened
90% of patients screened
9.Medication Initiation
50% of patients initiated
70% of patients initiated
90% of patients initiated
10.Medication Review
50% assessed 70% assessed 90% assessed
11.Communication Strategy
Communicates to doctor
Communicates to doctor w/ %50 criteria
Communicates to doctor w/ %90 criteria
12.Long-term Management
1 year follow-up 6 month follow-up & 1 year follow-up
13.Database Local Regional National
13 standards 5 categories 1 star
Fragility fracture categories
Achievement & valuation
1. Hip2. Inpatient3. Outpatient4. Vertebral5. Organizational
= 1
= 0.5
= 0.25
= 0
FLS Overall summary profile
Star Grade Calculation Score Map recognition
Hip Inpt OPD Vert Org
1+1+1+0.25+0.5 3.75
3.75
The Process
Step 1FLS submits online application
Step 2FLS entered on global map while being reviewed
Step 3BPF achievement level assigned
Step 4FLS is scored and recognized on the map
51 complete
29 in review
8 19 24
80 FLS80 FLS
Algeria Australia Belgium Brazil Bulgaria Canada China Czech Republic Finland France Greece India Ireland Italy Netherlands New Zealand Portugal Singapore Spain Sweden Switzerland Taiwan Trinidad & Tobago UK USA
Current mapping of FLS services
NEW! CtF toolkit
When?Available by the end of November 2014
What is it?A guide to facilitate the implementation of FLS worldwide
For whom?HCPs, health administrators, policymakers
Get Involved
• Visit www.capturethefracture.org to: Get mapped – Submit your FLS Join the coalition Sign up for the newsletter
• Be Active: Advocate for FLS implementation Encourage existing FLS to participate in Capture the Fracture Spread the word about FLS
Providers, politicians & patients drive change