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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