THU429 Improvement Of Osteoporosis Evaluation And Management In Patients Admitted With Hip Fractures At A Tertiary Level Academic Healthcare Institution In Manhattan
Authors: Haridas Keerthana , Cuan Katherine , Agarwal Rahul 
Published: October 2023

Abstract
Disclosure: K. Haridas: None. K. Cuan: None. R. Agarwal: None.
Objective: Osteoporosis is a widely prevalent disorder responsible for 1.5 million fractures annually resulting in high morbidity, mortality and financial sequelae. We conducted a quality improvement project to improve the diagnosis, evaluation and management of underlying osteoporosis in patients admitted with fragility hip fractures at our healthcare institutions and to understand the barriers to follow-up and thus, in setting up a fracture liaison clinic. Method: Patients admitted with pathological hip fractures were identified and provided educational handouts. Referrals were placed to outpatient Endocrinology for further evaluation and treatment. The status of follow up appointments in Endocrinology and other specialties was noted to evaluate barriers leading to attrition. Relevant steps were taken to address barriers by creating and implementing appropriate strategies. Effectiveness of the strategies was assessed by monitoring rates of outpatient follow up and strategies then permanently instituted or modified as appropriate. Results: 300 patients were included in the study. 278 patients (93%) had follow-up appointments scheduled, while 22 discharged patients did not due to scheduling deficits. Only 56 patients (21%) were present at their follow up appointments. All the patients who were seen at the clinic had appropriate evaluation and treatment of osteoporosis. Of the 79% of patients who cancelled their scheduled appointments, one third of patients (94 patients/ 33%) had a high rate of cancellation or absenteeism to other scheduled appointments as well, while 5 patients attended telehealth appointments only. Discussion: Only 10 to 20% of patients are treated for underlying osteoporosis after a fragility hip fracture. Fracture liaison services are interdisciplinary healthcare models for secondary and tertiary prevention of osteoporosis related complications in a population. Our project was designed to facilitate transition to this model. Despite high rates of designated follow up, significant attrition was noted. Debility due to old age, lack of understanding the need for timely treatment, socio-economic and logistic obstacles contribute to the same. In order to overcome the above barriers, steps proposed include having a designated member of staff meet with the patients during admission to coordinate further follow up for osteoporosis management, and to schedule telemedicine visits to bypass the barriers for physical attendance. In addition, patients will be liable to pay a no-show fee in the event of not attending follow-up appointments without prior notice. We also aim to contact providers in Orthopedics to coordinate referral of patients to Endocrinology during outpatient follow up visits post hospitalization and create a Fragility fracture Order set on Epic, containing a list of first line investigations and nutrient supplementation at discharge.
Presentation: Thursday, June 15, 2023