Fracture Liaison Services

Data, Pathways and Prevention

Will CarrService Development Project ManagerBristol 5/5/16

The National Osteoporosis SocietyThe only UK-wide charity dedicated to improving the prevention, diagnosis and treatment of osteoporosis• Vision: A future without fragility fractures• Mission: Working together for a brighter

future for people with or at risk of osteoporosis and fragility fractures across the UK, putting an end to preventable broken bones and helping people to live without pain and disability

3

• Low bone density/quality

• Lead to painful and debilitating fractures, often from low trauma events

• Many could be prevented with earlier diagnosis and treatment

4

5

• 300,000 fragility fractures a year• 85,000 are hip fractures• 1.8 million hospital bed days• 1 in 4 hip fracture patients will die within 1

year• 33% become totally dependent • £1.9 billion in hospital costs (excludes social

care costs)

What is the impact of fractures?Specifically hip fractures…

6

7

8

9

Fracture Liaison Service (FLS)• A FLS is a proven model for fragility fracture

prevention• 50% of hip fracture patients have had a prior

fragility fracture• All patients > 50 years who fracture are targeted• Clinically and cost effective

Find them

Assess them

Treat where appropriate Follow-up

An FLS Pathway

FALLS RISKASSESSMENT

NEW CLINICAL FRACTURE

NEW VERTEBRALFRACTURE

(RADIOLOGY REPORT)

PREVIOUS FRACTURE OR FRACTURE NOT PRESENTING

TO ACUTE CARE

ORTHO IP

Virtual/#CLINIC

‘CASE-FINDING’ BY FLS‘CASE-FINDING’ BY COTE

‘CASE-FINDING’ BY GP/SEC CARE/CH

FLS RISK ASSESSMENTONE-STOP CLINIC

WITH DXA

EXERCISECLASSES

Rx FOR FRACTURE 2Y PREVENTION

EDUCATIONPROGRAMME

CARE OF THE

ELDERLY

4 & 12 MONTH FOLLOW UP

CLINIC

COMPLEX CLINIC

(IF REQUIRED)

11

What are the benefits?An FLS directly:• Improves patients’ quality of care• Provides targeted intervention• Enables appropriate prescribing • Prevents pain/suffering• Reduces hospital admissions• Reduces hospital and social costs• Addresses QIPP

12

Glasgow Model• Glasgow assessed more than 50,000 fractures

between 2000-2010

• Hip fracture rates reduced by 7.3% vs 17% increase in England

• For every 1,000 patients, 18 fractures were prevented (11 hips)

Priorities and PlansAim 1: Every person aged over 50 who breaks a bone is assessed for osteoporosis and managed appropriately.Priority 1:

Extend coverage of Fracture Liaison Services in the UK

Priority 2:Improve quality of Fracture Liaison Services and osteoporosis services

• Facilitate stakeholder engagement• Help establish patient/care pathway• Project manage commissioning/funding:

o The economic and business caseo Service specificationo Resource and capacity planning

• Work with commissioners to ensure services are sustained.

How we help

15

How we can help you

Approval

NOS team can attend meetings and present /

support as required

7. Mobilisation8. Reporting /

evaluation

FLSP Training Provider, commissioner

Decision

6. Contract and performance

5. Service model and specfication

4. Business caseDecision

Performance framework and reporting tool

Draft available-compliant with NHS Std Contract

Benefits CalculatorCost Calculator

Draft using local template

1. Initial meeting 2. Gap analysis 3. Outline proposal

Facilitation and presentation of case

Team visit Draft using local template

16

The FLS Benefits Calculator

Available on line at http://benefits.nos.org.uk

What investment is required?• Staff costs – nurse and admin WTE• Consultant and radiography - sessional• Activity at tariff – DXA scans, nurse follow up,

consultant appointments• Set up costs – DXA scanner, training, • Other costs – prescribed medication, bloods

Costs = 37% of total benefits

18

How will you know if it is working?

Outcomes framework and reporting tool available for download from www.nos.org.uk/toolkit

Outcome Month 3 6 9 12 15 18 24Number of cases treated compared to predictedNumber of patient followed up at 4 monthsAdherence at 4 monthsNumber of patient followed up at 12 monthsAdherence at 12 monthsReduction in hip fractures admittedReduction in other fractures admitted

Outcome detected Outcome detected Statistically significant

with limited confidence outcome

19

FLS Implementation Toolkit

20

SDT Activity

21

FLS BenefitsArea Population Cohort

(50+)Hip fractures prevented*

Total benefits (of hip fractures prevented)*

Bradford 459,142 129,011 119 £1,991,822Colchester 332,923 134,835 142 £2,400,084East Surrey 177,566 63,474 65 £1,154,335East Sussex 374,801 167,905 188 £3,161,972Epsom 405,456 119,974 115 £2,066,895Rotherham 258,781 96,591 92 £1,540,356Salisbury 202,770 83,701 83 £1,412,992Stoke-on-Trent 214,991 88,334 88 £1,466,432Vale of York 348,363 131,411 128 £2,142,848Total 2,774,793 1,015,236 1020 £17,337,736*Over a 5 year period

22

Abstract deadline: 3 June 2016Earlybird registration deadline: 5 August 2016

www.nos.org.uk/conference

23

Will CarrThe National Osteoporosis SocietyCamertonBathBA2 0PJ

Tel: 07525987008Email: w.carr@nos.org.ukWebsite: www.nos.org.uk

Free phone Helpline: 0808 800 0035

Contact information