PROGRAMS PUT ALBERTA AT FOREFRONT OF HIP FRACTURE PREVENTION AND SURGICAL CARE
Alberta’s Bone and Joint Health Strategic Clinical Network has enlisted the support of ABJHI as it moves to put the province at the forefront of medical care for hip fracture while simultaneously working to reduce the number of hip fractures in the province.
Three program areas are under way, including one for preventing an initial fracture, one for preventing a subsequent fracture, and a third program for speeding access to surgery and maximizing the patient’s recovery potential.
ABJHI is coordinating the work with frontline health professionals at hospitals around Alberta while also gathering data to evaluate and report on the effectiveness of the programs.
PREVENTION PROGRAMS AIM TO KEEP ALBERTANS MOVING
Catch a Break: Albertans over the age of 50 who have had a fracture are being flagged for osteoporosis (OP) screening under a program called Catch a Break. Up to 80% of Albertans over 50 who have a fracture indicative of OP are not assessed or treated for the disease. Catch a Break aims to catch OP at the point of a minor fracture, averting a potentially devastating event, such as a hip fracture, which can put patients – especially the elderly – at high risk of physical and cognitive impairment, and even death.
Catch a Break is operated by the BJH SCN using the resources of Health Link, Alberta Health Services’ round-the-clock information phone line. A team scrutinizes information from hospital emergency departments and clinics across Alberta to identify patients who have had a low-trauma fracture, known as a fragility fracture, raising suspicion of OP. Team members contact these patients to assess them by phone. Patients found to be at high risk of OP are advised to see their family physician and are sent information about the disease and its treatment. The family physician is sent an information package, including the patient’s assessment, details about Catch a Break, and a summary of the clinical guidelines on investigating and treating OP. Health Link follows up with the patient at regular intervals to check on treatment progress.
The BJH SCN’s Catch a Break is emerging as a model of how public health care systems can generate high value at low cost by making innovative use of existing resources. Catch a Break costs about $350,000 a year to operate. Avoiding a single hip fracture saves the public health system $21,000 in treatment costs in the first year alone, rising to $44,000 if long-term care is needed.
In its first 18 months of operation, Catch a Break:
- Screened approximately 13,000 Albertans for osteoporosis.
- Identified 9,200 Albertans as being at high risk of osteoporosis and referred them to primary care.
Fracture Liaison Services: Operated in parallel with Catch a Break, Fracture Liaison Services (FLS) is designed to prevent a subsequent hip fracture. The BJH SCN is phasing in FLS at hospitals using ABJHI to coordinate the implementation. Anyone age 50 or older who enters a participating hospital with a fractured hip is assigned a dedicated FLS team, including a registered nurse and a physician. The team does a comprehensive assessment of these patients for osteoporosis (OP) and geriatric-related medical conditions that put them at risk of falling and fracturing again. OP medication is initiated as needed and patients are referred to services, such as fall prevention and memory improvement programs, that help reduce their risk. The team follows each patient for 12 months with the nurse serving as case manager coordinating referrals to other health professionals, ensuring patients are complying with their treatment regimen, and monitoring for medication side effects. At 12 months, management of the patient’s condition is transferred to a family physician.
The BJH SCN has introduced FLS at Misericordia, University of Alberta, and Royal Alexandria hospitals in Edmonton, Calgary’s Peter Lougheed Centre, and Red Deer Regional Hospital. Further expansion is coming.
FLS generates high value at low cost. For every 100 hip fracture patients assessed through FLS, an estimated four hip fractures are prevented avoiding a devastating loss of quality of life, significantly reducing the risk of mortality and saving the public health system $260,000 in care costs. These benefits come at a program cost of less than $60 per patient.
For every 100 hip fracture patients assessed through Fracture Liaison Services:
- 4 hip fractures prevented.
- Devastating loss of quality of life avoided.
- Risk of mortality significantly reduced.
- $260,000 in public health care costs avoided.
These benefits come at a program cost of less than $60 per patient.
QUICK PATH TO OPERATING ROOM AND EARLY MOBILITY
Hip Fracture Acute Care Path: Alberta’s care path for hip fracture surgery emphasizes a quick path to the operating room, getting patients up and moving on the day of surgery, minimizing the stay in hospital, and getting patients back to their pre-fracture living environment.
The care path sets out the practices and protocols to be followed along the patient’s journey from first arriving in a hospital or clinic with a fractured hip through surgery and recovery in acute care. It is based on the best evidence available. The evidence shows patients who have surgery within 48 hours of first presenting with the fracture and who are up and moving on the day of surgery have the best outcomes. Their risk of complications and mortality is reduced. They also regain more function, are discharged from the acute care hospital sooner, and are more likely to return to where they lived prior to the fracture.
The hip fracture acute care path was implemented by the BJH SCN in 2011. ABJHI coordinated the implementation at hospitals and has been helping the BJH SCN embed the care path in everyday practice across Alberta. ABJHI is also gathering and analyzing data to help the BJH SCN monitor the care path’s performance against benchmarks. Performance is being analyzed in multiple key areas, such as wait time for surgery, elapsed time between surgery and the patient’s first attempt to get up and walk, duration of hospital stay, and the rate of patient return to the pre-fracture living environment.
HIP FRACTURE PREVENTION PROGRAM BASED ON OSTEOPOROSIS CANADA’S 3i MODEL
Alberta’s Fracture Liaison Services program is based on Osteoporosis Canada’s 3i model, which has three objectives:
- Identification – assess for osteoporosis risk everyone over the age of 50 who experiences a fracture indicative of fragile bones.
- Investigation – perform bone mineral density tests on individuals identified as having risk factors for osteoporosis.
- Initiation – begin osteoporosis treatment as appropriate.
Visit the New Web Page for Fracture Liaison Services
The BJH SCN has launched a web page making its Hip Fracture Care Pathway toolkit available to the public and health care professionals. The toolkit includes tips on preventing hip fracture, and the latest tools and resources, including surgery and post-surgery care paths. Among the resources available to patients are posters illustrating precautions that must be taken following surgery to avoid injuring the repaired hip.