Carolinas HealthCare System Fragility Fracture Program

Transcription

1 Carolinas HealthCare System Fragility Fracture Program Presented By: Monica C. Mowry, MSN, RN, NE-BC, ONC Director, Clinical Program Development Carolinas HealthCare System Charlotte, NC Objectives Expand current knowledge about Fragility Fractures Implications on Senior Patient Population Benefits of Developing/Implementing a Fragility Fracture Program What are Fragility Fractures? Fractures from a low energy trauma Slip/trip/fall from standing height or less Most common fracture sites Hip/Femur Distal Radius Proximal Humerus Vertebral Compression nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 1

2 Osteoporosis Diagnosis Osteoporosis can be diagnosed by: DEXA scan* Presence of Fracture resulting from a low energy fall Low energy fracture is diagnostic of osteoporosis (in the absence of other pathologies: neoplasm) World Health Organization A Call To Action A woman s risk of breaking a hip due to osteoporosis is equal to her risk of breast, ovarian and uterine cancer combined. And a man age 50 or older is more likely to break a bone due to osteoporosis than he is to get prostate cancer. -National Osteoporosis Foundation, 2016 Much of the burden of bone disease can potentially be avoided if at-risk individuals are identified. One of the most important flags a previous fragility fracture. - Surgeon General s Report on Bone Health, 2004 Osteoporosis is responsible for two million broken bones and $19 billion in related costs every year. By 2025, experts predict that osteoporosis will be responsible for Approximately three million fractures and $25.3 billion in costs each year. - National Osteoporosis Foundation Fragility Fracture Prevalence 2,500,000 2,100,000 2,000, ,000 Wrist 1,500,000 1,000, , ,000 Vertebral 350,000 Hip 125,000 Pelvic 675,000 Other 795, , ,000 0 Fragility Fractures Stroke Heart Attack Breast Cancer nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 2

3 Current Treatment Gap National Committee for Quality Assurance Medical Evaluation 2009: HMO Statistics Program Development & Spread Summer 2010 endorsed by CHS Clinical Innovations Council and Business Innovation Council Program developed using the University of Rochester Geriatric Fracture Center model Launched at CMC in November 2010 as a cooperative partnership between the Inpatient Medical Service (CHG, Staff Med, Charlotte Medical Clinic) and the Department of Orthopedics Between Fragility Fracture Program adopted at an additional 8 facilities Program Guiding Principles Orthopaedic/Medical Co-Management Model To manage complex medical issues AND fracture care Multi-disciplinary Team approach Role for Nursing, Physical Therapy, Case Management Bone Health assessment while in-patient Vitamin D and Calcium level evalulation Organized discharge planning efforts Referral for other needed services, communication to next level of care to ensure appropriate follow-up nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 3

4 Standardization of Care Physician Order Sets Centralized Data Collection Process Standardized Program dashboards Identified local program champions Administration, Nursing, Physician Defined communication process with local teams Standardized staff/patient education materials Standardized discharge note to guide follow-up care Program Guiding Principles Include men and women > 55 years of age In-patient admission for fracture (low-energy fall) Rapid ED admission process Clearly defined admission guidelines Fast-track to OR for operative cases Minimize unnecessary testing, early pre-op clearance Ortho/Medicine co-management model Optional referral to Fall Prevention Program Full Continuum of Care Mission and Vision: A) Evidence-Based Guidelines, Clinically Integrated Across the Continuum of Care B) Address the Needs of Patients in their Local Communities: Right Care, Right Place, Right Time C) Systematic Approach to Data, PI, Research D) Transparent Communication System nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 4

5 Patient Outcome Measures Length of Stay Mortality Readmission Rate New in 2016 Morbidity 12 month post-fracture Readmission Rate Program Process Measures Utilization of Standardized Order Set Completion of Bone Health Labs Admitting Service Use of Ortho/Med Co-Management Model Time to O.R. (for surgical cases) Documentation of Fragility Fracture patient education Discharge Disposition nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 5

6 Big WINS Baseline 2014 Finalized Length of Stay 6.48 days 5.21 days Readmission Rate 13.85% 6.75% Mortality Rate 1.54% 1% Use of Order Set 0 81% Time to O.R. <24hr 41% 78% FF Education Documented 0 81% Next Steps Further integration in Ambulatory/PCP domain Refinement of Communication at key Transition Points Partnerships with Community Para-Medicine Fall Risk Prevention Further integration with Geriatrician Group Further integration with NICHE initiatives Continuous improvement in Process/Outcome Measures Summary Fragility Fractures area serious issue facing our Senior population The most common type of Fragility Fractures are Hip Fractures Hip Fractures can be life-changing for Seniors Fragility Fractures place a substantial social and economic strain on Healthcare Systems Fragility Fractures can be PREVENTED!!! nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 6

7 Summary Osteoporosis and Fragility Fractures are MOST prevalent in the Senior patient population Seniors are a growing segment of the population Prevalence of Osteoporosis and Fragility Fractures are expected to rise in the coming years Development of a Fragility Fracture program can Reduce LOS Reduce Mortality Reduce Readmissions Questions??? nicheprogram.org 2016 Annual NICHE Conference Care Across the Continuum 7