Invited Commentary: Fracture Follow-Up Program in an Open Healthcare System
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THE WHY AND HOW OF FRACTURE LIAISON SERVICES (SL SILVERMAN, SECTION EDITOR)
Invited Commentary: Fracture Follow-Up Program in an Open Healthcare System M. K. Oates
Published online: 13 September 2013 # Springer Science+Business Media New York 2013
Abstract The basis of the Fracture Liaison Service is to identify and treat those patients at highest risk of suffering a second fracture. The execution of this type of program poses unique challenges in open healthcare settings that lack a central coordination of patient care. This invited editorial reviews the establishment and operation of The Marian Osteoporosis Center at Marian Medical Center in Santa Maria, California. Keywords Fracture liaison service . Osteoporosis . Fragility fracture . DXA . Secondary prevention . Quality improvement . Ultrasound
Introduction The basis of the Fracture Liaison Service is to identify and treat those patients at highest risk of suffering a second fracture. Excellent models have been developed in several countries including China, UK, Canada, and the US, namely the Kaiser Healthy Bones program and Geisinger Clinic. These programs were either developed in countries with socialized medicine or in an American Managed care system with a broad network of health providers who coordinate and ensure care under a single health directive and a minimal number of paper or electronic databases. The main goals of the hospitals, healthcare providers, patients, and insurance administrators are aligned. However, most patients who suffer an osteoporotic fracture are not enrolled in a closed or managed care system. They receive distinctly separate and uncoordinated care from so many different entities that in the case of patients that are 50 years and older with fragility fractures, nationally, M. K. Oates (*) Marian Osteoporosis Center, 116 S. Palisade Drive, 200, Santa Maria, CA 93454, USA e-mail: [email protected]
only 7 % receive treatment for underlying osteoporosis, according to Jennings et al. (Osteoporos Int. 2013;2135–52). This article will chronicle our experience establishing, funding, managing, revising, and expanding The Marian Osteoporosis Center. The Marian Osteoporosis Center began in 2008 at Marian Regional Medical Center in Santa Maria, California. It was initially established with a private donation to our non-profit Marian Medical Center Foundation earmarked to develop a multidisciplinary approach to osteoporosis for vulnerable patients. I personally wrote the grant application and received administrative support throughout the process. Our mission was to provide access for all patients in the Santa Maria Valley to screening, fall prevention, physical therapy, nutrition counseling, and medication recommendations. At that time, we were very lucky that our hospital already had an established Congestive Heart Failure program and a clinical nurse navigator for the cancer program. We modeled our program after their success with community education and quality improvement. We started the program in 2008 with myself acting a
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