In Catch a Break’s first year of operation, Health Link staff identified 7,323 Albertans at high risk of osteoporosis out of a screened list of 10,093 Albertans that suffered a sentinel fracture. Another 3,282 subjects were unable to be contacted and a further 2,422 subjects declined to participate in the provincial screening program. At the time of this report, 6,048 (83%) had followed up with their primary care physician concerning their fracture, 767 (10%) were in the contact queue for follow-up by Health Link, and 401 (5%) were lost to follow-up. Respondents reported that their daily use of calcium and vitamin D increased following enrolment in Catch a Break and receiving education materials; daily use of calcium increased to 68% from 47% (p=0.001), and daily vitamin D use increased to 78% from 63% (p=0.002). In the subset of high risk participants who had not followed up with their primary care physician regarding their fracture at initial contact, the proportion that underwent bone mineral density screening at the three months post-fracture increased to 74.9% from 61.6% (p<0.001). Similarly, the proportion of this subset indicating that they were prescribed osteoporosis medication increased to 15.2% from 7.1% (p<0.001). Preliminary analysis suggests that the rate of subsequent fracture within one year in Alberta for sentinel fracture cases has been relatively stable since January 2011, averaging around 2.6% (± 0.4%). There is insufficient data to yet determine whether the rate of subsequent fracture has experienced a shift or change in overall trend, although early results indicate downward movement in Edmonton and Calgary zones. Further validation is also needed to ensure that the algorithm developed by the Alberta Bone and Joint Health Institute is able to accurately distinguish between subsequent fracture cases and follow-up care for the initial fracture. There is a known limitation in the available data that is expected to result in underreporting of the rate of vertebral fractures, since many of such fractures are not captured in visits to emergency department or urgent care centres.

ABSTRACT OBJECTIVE To evaluate hospital administrative data to identify potential surgical site infections (SSIs) following primary elective total hip or knee arthroplasty. DESIGN Retrospective cohort study. SETTING All acute care facilities in Alberta, Canada. METHODS Diagnosis and procedure codes for 6 months following total hip or knee arthroplasty were used to identify potential SSI cases. Medical charts of patients with potential SSIs were reviewed by an infection control professional at the acute care facility where the patient was identified with a diagnosis or procedure code. For SSI decision, infection control professionals used the National Healthcare Safety Network SSI definition. The performance of traditional surveillance methods and administrative data–triggered medical chart review was assessed. RESULTS Of the 162 patients identified by diagnosis or procedure code, 46 (28%) were confirmed as an SSI by an infection control professional. More SSIs were identified following total hip vs total knee arthroplasty (42% vs16%). Of 46 confirmed SSI cases, 20 (43%) were identified at an acute care facility different than their procedure facility. Administrative data–triggered medical chart review with infection control professional confirmation resulted in a 1.1- to 1.7-fold increase in SSI rate compared with traditional surveillance. SSIs identified by administrative data resulted in sensitivity of 90% and specificity of 99%. CONCLUSION Medical chart review for cases identified through administrative data is an efficient supplemental SSI surveillance strategy. It improves case-finding by increasing SSI identification and making identification consistent across facilities, and in a provincial surveillance network it identifies SSIs presenting at nonprocedure facilities. Infect. Control Hosp. Epidemiol. 2016;1–5