Fracture prevention pathway in South Central

Proposed patient pathwayBone treatment pathwayAdministration pathway

400

500 560

610

175360

600380

160

140

375

4260 hip fractures

~12,800 non-hip fragility fractures

Current status: How many fractures?

After the first fracture, act to prevent the second

Fracture prevention is cost releasing

Inpatient only

50% only Inpatient only

No

NoNo

NoNo

No

Inpatient only

No

No 100% provision of fracturePrevention services in SC

Current status: How many fracture prevention services?

“After the first fracture, act to prevent the second...anywhere within South Central ”

CoordinatedImplementation

Equitable

Effective

Evidence based

Community clinics: FPN + GPSi

Risk factors: bone + mini Falls

BloodsRx

Monitoring for 5 years:

Adherence Side effects / Re #

OUTPATIENT FRACTURE CLINIC

TRAUMA

Secondary careNon- surgical (pelvic/ T/L

#)

NOF Non NOFAdmitted non-trauma

Community bed/ Care home

DXA appropriate?

NO

ASSESS Bone/ mini-FallsTREAT/ REFER

YES

DXA + falls triage

REFERRAL

Strategic Critical Success factors• To make savings in medium to long term, across the total health and social

care pathway through reduction in re-admissions from recurrent fracture and falls.

• To improve the quality of the experience for the individual and their family, by developing equality of access to information and management of all fragility fractures

• To support best practice in the care of people who have fragility fractured

Range of Targets• To reduce by 30% reduction in the re-current all fracture rate• To reduce by 50% the re-current hip fracture rate• To reduce by 50% the re-current fall rate• To reduce by 10% all fractures in the over 65 population from the predicted

population growth (local target in place since April 2009)• A 20% reduction in non-conveyed falls seen by the ambulance service in

patients with a previous history of fracture• Corresponding reduction in care home placements and in domiciliary packages • Reduction of patients referred to Nuffield Orthopaedic Centre, Metabolic Bone

clinic and CHO Falls clinic• To improve case finding of fragility fracture patients presenting to acute care. • To increase the percentage of fragility fracture patients receiving falls and

bone health assessment (questionnaire, bloods, DXA)• All individuals with a fragility fracture are put on to an individual management

plan

The next step

• This is a big change in practice• 2 pilots for specific aspects of case finding, falls and bone assessment at

JR Trauma OPD by both falls and bone health staff

• Test before commissioning more widely

• Propose a 6 month feasibility study– 2.0 Nurses– 0.5 Admin– Prototype database– Clear productivity, cost and quality outcome metrics…..to justify full

commissioning across the region