Category: Best Practices for Osteoporosis Management

25 - Role of a High Risk Osteoporosis Consult (HiROC) Service in Patients With Hip Fractures in the Inpatient and Post-Discharge Setting

Introduction: Osteoporosis and associated fractures are medical conditions with substantial morbidity and mortality. Because these are highly preventable conditions, the widespread adoption and implementation of quality metrics have created pressures on hospitals to improve delivery and quality of care. Several healthcare systems in the USA have developed promising programs to address these metrics. However there have been few studies that look at the role of a fracture liaison inpatient service as a bridge to continued therapy in the post-discharge setting.

Objectives: This study assesses the effectiveness of a High Risk Osteoporosis Consult (HiROC) service via an electronic medical record intervention at the University of Texas (UT) Southwestern in implementing appropriate preventative and therapeutic measures in patients with minimal trauma fractures in the inpatient setting. This study also looks at the effectiveness of the HiROC service in providing continued appropriate treatment in the post-discharge period.


Methods:
Seventy- five consecutive patients above the age of 50 admitted with minimal trauma hip fractures from March 2014 to March 2015 formed the group intervened on by HiROC. Thirty-four age-matched patients with minimal trauma hip fractures admitted from January 2012 to January 2013 and enrolled in inpatient post-fracture physical therapy served as our comparison group. Retrospective follow-up chart review was conducted to check if patients were following recommended therapy in the inpatient and post-discharge setting.


Results:
Following HiROC intervention, a significantly higher proportion of patients had a serum Vitamin D measured prior to discharge (87% vs. 21%, p < 0.001), initiation of Calcium supplementation prior to discharge (93% vs. 24%, p < 0.001), initiation of vitamin D supplementation (96% vs. 18%, p < 0.001), and initiation of pharmacotherapy by discharge (33% vs. 0%, p < 0.001). A non-statistically significant improvement was found in bone densitometry (DXA) ordered post-fracture (33% vs. 21%, p=0.175).

Subgroup analysis revealed 53% (n=40) of patients had confirmed outpatient appointments near time of discharge and of these 22 came. All follow up visits were within 6 months of discharge with average time to follow up of 60 days. Importantly, of those seen in outpatient clinic, 86% (n=19) received pharmacotherapy.


Conclusion:
Use of an EMR auto-notification to a HiROC service improved quality of care for patients with osteoporosis related hip fractures in the inpatient and post-discharge setting. Further study is needed to increase measurement of bone mineral density by DXA, improve patient follow-up and increase use of appropriate pharmacotherapy.

Ugis Gruntmanis

Associate Program Director, Professor
University of Texas Southwestern Medical Center
Dallas, Texas

Mehwish Ismaily

Internal Medicine Resident
University of Texas Southwestern Medical Center
Dallas, Texas