scholarly journals Cost‐effectiveness of secondary fracture prevention intervention for Medicare beneficiaries

2021 ◽  
Author(s):  
Smita Nayak ◽  
Andrea Singer ◽  
Susan L. Greenspan
Keyword(s):  
Cost Effectiveness ◽  
Fracture Prevention ◽  
Medicare Beneficiaries ◽  
Secondary Fracture ◽  
Secondary Fracture Prevention ◽  
Prevention Intervention

scholarly journals Models of care for the delivery of secondary fracture prevention after hip fracture: a health service cost, clinical outcomes and cost-effectiveness study within a region of England

2016 ◽  
Vol 4 (28) ◽  
pp. 1-170 ◽  
Author(s):  
Andrew Judge ◽  
M Kassim Javaid ◽  
José Leal ◽  
Samuel Hawley ◽  
Sarah Drew ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hip Fracture ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Fracture Prevention ◽  
Service Evaluation ◽  
Models Of Care ◽  
Secondary Fracture ◽  
Secondary Fracture Prevention ◽  
Prevention Services

BackgroundProfessional bodies have produced comprehensive guidance about the management of hip fracture. They recommend orthogeriatric services focusing on achieving optimal recovery, and fracture liaison services (FLSs) focusing on secondary fracture prevention. Despite such guidelines being in place, there is significant variation in how services are structured and organised between hospitals.ObjectivesTo establish the clinical effectiveness and cost-effectiveness of changes to the delivery of secondary fracture prevention services, and to identify barriers and facilitators to changes.DesignA service evaluation to identify each hospital’s current models of care and changes in service delivery. A qualitative study to identify barriers and facilitators to change. Health economics analysis to establish NHS costs and cost-effectiveness. A natural experimental study to determine clinical effectiveness of changes to a hospital’s model of care.SettingEleven acute hospitals in a region of England.ParticipantsQualitative study – 43 health professionals working in fracture prevention services in secondary care.InterventionsChanges made to secondary fracture prevention services at each hospital between 2003 and 2012.Main outcome measuresThe primary outcome is secondary hip fracture. Secondary outcomes include mortality, non-hip fragility fracture and the overall rate of hip fracture.Data sourcesClinical effectiveness/cost-effectiveness analyses – primary hip fracture patients identified from (1) Hospital Episode Statistics (2003–13,n = 33,152); and (2) Clinical Practice Research Datalink (1999–2013,n = 11,243).ResultsService evaluation – there was significant variation in the organisation of secondary fracture prevention services, including staffing levels, type of service model (consultant vs. nurse led) and underlying processes. Qualitative – fracture prevention co-ordinators gave multidisciplinary health professionals capacity to work together, but communication with general practitioners was challenging. The intervention was easily integrated into practice but some participants felt that implementation was undermined by under-resourced services. Making business cases for a service was particularly challenging. Natural experiment – the impact of introducing an orthogeriatrician on 30-day and 1-year mortality was hazard ratio (HR) 0.73 [95% confidence interval (CI) 0.65 to 0.82] and HR 0.81 (95% CI 0.75 to 0.87), respectively. Thirty-day and 1-year mortality were likewise reduced following the introduction or expansion of a FLS: HR 0.80 (95% CI 0.71 to 0.91) and HR 0.84 (95% CI 0.77 to 0.93), respectively. There was no significant impact on time to secondary hip fracture. Health economics – the annual cost in the year of hip fracture was estimated at £10,964 (95% CI £10,767 to £11,161) higher than the previous year. The annual cost associated with all incident hip fractures in the UK among those aged ≥ 50 years (n = 79,243) was estimated at £1215M. At a £30,000 per quality-adjusted life-year threshold, the most cost-effective model was introducing an orthogeriatrician.ConclusionIn hip fracture patients, orthogeriatrician and nurse-led FLS models are associated with reductions in mortality rates and are cost-effective, the orthogeriatrician model being the most cost-effective. There was no evidence for a reduction in second hip fracture. Qualitative data suggest that weaknesses lie in treatment adherence/monitoring, a possible reason for the lack of effectiveness on second hip fracture outcome. The effectiveness on non-hip fracture outcomes remains unanswered.Future workReliable estimates of health state utility values for patients with hip and non-hip fractures are required to reduce uncertainty in health economic models. A clinical trial is needed to assess the clinical effectiveness and cost-effectiveness of a FLS for non-hip fracture patients.FundingThe National Institute for Health Research (NIHR) Health Services and Delivery Research programme and the NIHR Musculoskeletal Biomedical Research Unit, University of Oxford.

scholarly journals Low-Energy Pelvic Ring Fractures: A Care Conundrum

2021 ◽  
Vol 12 ◽  
pp. 215145932098540
Author(s):  
Bailey R. Abernathy ◽  
Lisa K. Schroder ◽  
Deborah C. Bohn ◽  
Julie A. Switzer
Keyword(s):  
Acute Care ◽  
Patient Population ◽  
Pelvic Ring ◽  
Fracture Prevention ◽  
Low Energy ◽  
Care Pathways ◽  
Secondary Fracture ◽  
Secondary Fracture Prevention ◽  
Pelvic Ring Fractures ◽  
Rehabilitative Care

Introduction: A need exists for improved care pathways for patients experiencing low-energy pelvic ring fractures. A review of the current literature was performed to understand the typical patient care and post-acute rehabilitation pathway within the US healthcare system. We also sought to summarize reported clinical outcomes worldwide. Significance: Low-energy pelvic ring fracture patients usually do not qualify for inpatient admission, yet they often require post-acute rehabilitative care. The Center for Medicare and Medicaid Services’ (CMS) 3-day rule is a barrier to obtaining financial coverage of this rehabilitative care. Results: Direct admission of some patients to post-acute care facilities has shown promise with decreased cost, improved patient outcomes, and increased patient satisfaction. Secondary fracture prevention programs may also improve outcomes for this patient population. Conclusions: Post-acute care innovation and secondary fracture prevention should be prioritized in the low-energy pelvic fragility fracture patient population. To demonstrate the effect and feasibility of these improved care pathways, further studies are necessary.

scholarly journals Secondary Fracture Prevention

2020 ◽  
Vol 39 (3) ◽  
pp. 145-161
Author(s):  
Robert B. Conley ◽  
Gemma Adib ◽  
Robert A. Adler ◽  
Kristina E. Åkesson ◽  
Ivy M. Alexander ◽  
...  
Keyword(s):  
Fracture Prevention ◽  
Secondary Fracture ◽  
Secondary Fracture Prevention

scholarly journals PAO22 REFILL ADHERENCE IN OSTEOPOROTIC WOMEN WITH PRIMARY AND SECONDARY FRACTURE PREVENTION

2002 ◽  
Vol 5 (3) ◽  
pp. 185-186
Author(s):  
CD Beilfuss ◽  
MJ Wall ◽  
JS Graff ◽  
CR McBurney ◽  
AM Fendrick
Keyword(s):  
Fracture Prevention ◽  
Secondary Fracture ◽  
Secondary Fracture Prevention ◽  
Refill Adherence

scholarly journals Early benefits of a secondary fracture prevention programme

2021 ◽  
pp. 112070002110274
Author(s):  
Gershon Zinger ◽  
Noa Sylvetsky ◽  
Yedin Levy ◽  
Kobi Steinberg ◽  
Alexander Bregman ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Fracture Risk ◽  
Fragility Fracture ◽  
Intervention Group ◽  
Fracture Prevention ◽  
Intervention Programme ◽  
Secondary Fracture ◽  
Secondary Fracture Prevention ◽  
Randomised Study ◽  
Dexa Scan

Introduction: The most successful programme for secondary fracture prevention is the FLS (fracture liaison service) model. Our orthopaedic department carried out a prospective randomised study to measure the effectiveness of a 4-step intervention programme. The findings in this study reveal important additional clinical benefits to having an orthopaedic-based FLS programme and evaluates the usefulness of fracture risk tools. Methods: We carried out a prospective study to evaluate patients with a fragility fracture of the hip. There were 2 groups, intervention and control (each 100 patients). Of these, 20 were either removed from the study or dropped out, leaving 180 for analysis. In addition to routine preoperative blood tests, albumin and thyroid function levels were obtained and PTH (parathyroid hormone) levels when indicated. The intervention group (83 patients) had a dual-energy x-ray absorptiometry (DEXA) scan performed and fracture risk (FRAX) was calculated. Results: 12 patients (6.7%) had blood results which showed a potentially treatable cause for osteoporosis and 36 (20%) had blood results that changed their medical care. FRAX scores (180 patients) showed that the major osteoporotic fracture score correctly predicted the hip fracture in only 49%. The hip fracture score correctly predicted the hip fracture in 83%. DEXA scores (65 patients) showed osteoporosis in only 46% of hips and in only 26% of spines. An abnormal FRAX score or DEXA scan would have predicted a fragility fracture 93% of the time. Conclusions: In addition to reducing secondary fractures, FLS programmes can provide fundamental benefits to the health of the patient. The intervention programme in this study identified patients with underlying treatable causes, correctable clinical conditions and patients with an unusually low bone density. When used together, FRAX and DEXA are more sensitive predictors for hip fracture risk than either are individually. Trial registry: 201497CTIL ( https://clinicaltrials.gov/ct2/show/NCT02239523 )

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