Category: Best Practices for Multidisciplinary Care Coordination

4 - The Value of Collaborative Fracture Liaison Service As Experienced by People with Osteoporosis: An Exploratory Focus Group Study

In the United States, only 5% of patients with osteoporosis are properly diagnosed. The Kaiser Permanente Healthy Bones Program is globally recognized as a best Fracture Liaison Services (FLS) practice to proactively identify, screen, and treat people at risk for osteoporosis. The purpose of this qualitative study is to explore the value of the program as perceived by members. A secondary purpose is to elicit information about members’ knowledge about the collaborative efforts provided to improve patient care experiences and health outcomes.

Background: The growing aging population carries a high prevalence of osteoporosis and fracture-related morbidity and mortality. Each year about 24% of elderly patients sustain a hip fracture, and 50% of patients will never resume prior functional ability. The mortality rate exceeds more than 25% in the first year. The International Osteoporosis Foundation advocates FLS as best practice that ensures appropriate osteoporosis diagnosis, treatment and follow up for fracture patients. No data has been gathered to explore the patients’ care experiences with the Healthy Bones Program.

Two focus group interviews were conducted with 6 participants per group, for a total of 12 participants at Fontana Kaiser Permanente Medical Center in California, using semi-structured, open-ended and prompting questions to gain participants’ detailed insights. All recorded interviews were professionally transcribed verbatim. Qualitative content analysis and interpretive processes were utilized to facilitate better understanding of participants’ care experiences and perceptions. NVivo software was used to assist in coding, and generate reports of coded text for analysis. A word cloud was developed to enhance a visual representation of overlapping themes within the study.

Eight cluster themes and subthemes were identified, such as fragmented care to coordinated care, health education to patient empowerment, interprofessional communication and collaboration, health information technology transforming integrated healthcare, healthcare provider directed care to patient directed care, patient self-advocacy and care involvement, quality patient care experiences and care improvement advocacy. The electronic health records were recognized to facilitate osteoporosis care coordination. Bone health education was valued as effective intervention to empower osteoporosis self-care management.

Implications: In today’s complex healthcare systems, the study findings capturing patients' voices can contribute to the program evaluation and program improvement. The implementation of innovative health information technology enhances osteoporosis care coordination. The results will be disseminated at the local, national and international levels, to transform collaborative, evidence-based osteoporosis care.

Sharon K. Chow

Nurse Practitioner Care Manager
Kaiser Permanente
Pomona, California