Category: Best Practices for Osteoporosis Management

14 - Outpatient HiROC Program Analysis 2014

Introduction: We previously published the development of a ‘separate’ outpatient HiROC pathway in Geisinger Health System (GHS), reporting a 200 patient random sample with clinical variables, demographics and treatments. This current analysis aimed to better understand and identify areas for improvement in outpatient HiROC pathway.


Methods:
The EMR records of 511 new outpatient HiROC consultation visits seen from 01/01/2014 through 12/31/2014 were obtained through our data registry. We documented the following clinical variables: age, sex, fracture risk categories (fracture, T-score, FRAX, GIOP, treatment); vitamin D levels; bisphosphonate holidays; drugs used; reason for consult; treatment indicated or not; follow-up; lost to follow-up.


Results:
Table 1 shows that 458/511 (89.2%) were high-risk, where drug therapy was indicated. Remaining patients were either low-risk, 50 patients (9.8%) or unknown risk – 5 patients (1%).

Table 2 shows demographic and clinical variables. Mean age was 70 years, with 406 patients (89%) female, 50 patients (11%) male. Reasons for outpatient HiROC Consultation included: T-score
Table 3 shows that 64.7% were seen at a 1-year follow-up interval; at 2 years, 60.2% of cohort was seen. We found 172 patients (37.8%) lost to follow-up care. Mortality was 4.4%.


Conclusions:
We show that 83.6% of the 2014 outpatient HiROC high-risk patients were started on a medication, compared to 89% of the 200 patient random sample previously reported. Surprisingly, but similar to what was documented within inpatient HiROC pathway 2013-2015 analysis, a similar percentage of patients were lost to follow-up. Importantly, we aim to understand why this happens and create solutions to lower the lost to follow rates. We strongly believe that a newer, more sophisticated data registry will help identify care gaps in real time, allowing real time solutions. Additionally, other resources including new HiROC team personnel; blocked time for active, prospective performance analysis; and new strategies to enhance scheduling, detect no-shows and patient cancellations will yield better performance in this population at risk for future fractures





Philip Dunn

Rheumatology Fellow
Geisinger Medical Center
Danville, Pennsylvania

Thomas Olenginski

Rheumatologist
Geisinger Medical Center
Danville, Pennsylvania