Bone fractures in patients with osteoporosis, called fragility fractures, are one of the most common trauma conditions treated by hospitals. According to the National Osteoporosis Foundation, more fragility fractures occur each year than heart attacks, strokes, and newly diagnosed breast cancer cases combined. The American Academy of Orthopaedic Surgeons estimates that more than 2 million fragility fractures occur in the United States annually, costing about $19 billion in healthcare costs - a price tag that is expected to balloon to $25.3 billion by 2025 as the country's population ages. Unfortunately, poor care coordination for this typically elderly patient population often results in significant complications, readmissions, and mortality rates.
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The challenge for hospitals is that fragility fracture patients are often dealing with more than just a broken bone. Fragility fractures in the most common sites, such as the hip and vertebra, are associated with increased disability, reduced quality of life, and a downward spiral in physical and mental health. Additionally, these patients tend of have other underlying and sometimes untreated medical conditions that complicate their care. When not managed efficiently, fragility fracture patients may experience long delays in undergoing surgery and extended lengths of stay, putting them at risk for infection, a longer recovery timeline, hospital readmission, and generally less-than-optimal outcomes. Studies show that the one-year mortality rate for fragility fracture patients is about 30 percent.
Part of the difficulty for hospitals is that fragility fracture patients require care from multiple service lines - emergency medicine, orthopedics, anesthesiology, internal medicine --from the time a fragility fracture patient enters the hospital, receives surgery, and is treated for any underlying medical issues. Physicians in these specialties or departments have traditionally not coordinated well with one another.
To improve care and outcomes for this patient population, lower costs associated with readmissions, and raise patient satisfaction scores, hospitals can consider implementing a fragility fracture program where each provider in the patient's chain of care works together in an integrated manner. By following protocols and pathways specifically designed to manage these high-risk and high-cost cases, providers can deliver better coordinated and more efficient care. When managed properly, a fragility fracture program can help hospitals reach the Triple Aim goals of improving the patient experience and the health of their geriatric patient populations while reducing hospital costs.
In a fragility fracture program, when a patient presents to the hospital with certain types of fractures, the diagnosing physician sets a specific protocol in motion for all relevant caregivers. The protocol is designed to provide the optimal experience. For example, when an elderly patient presents to the emergency department with a hip fracture, the emergency physician notifies the hospital medicine department, the orthopedic surgeon, the anesthesiology department, the therapy department, the fracture liaison service, and the discharge planning department. Each department then begins working through predetermined and interrelated processes that help efficiently move the patient through the care process toward discharge.
When all of the required departments coordinate with each other, many patients may be able to receive surgery the same day, which shortens the hospital stay and helps lower infection risk. These patients also experience higher levels of satisfaction resulting from the increased coordination and communication among providers and with the patient. The better coordinated care results in fewer complications, and coordinated post-discharge care and follow-up results in fewer readmissions and lower secondary fracture rates.
Baptist Memorial's Fragility Fracture Program
Baptist Memorial Hospital in Memphis, Tennessee, operates an exemplary fragility fracture program. This not-for-profit hospital treats more than 200 geriatric fragility cases annually. The hospital implemented its fragility fracture program in late 2014 by integrating care across all services involved in the treatment of geriatric hip fracture patients. Baptist Memorial has seen great results - a 30 percent decrease in length of stay for fragility fracture patients and zero readmissions from this patient population, which was down from an approximate readmission rate of 8 percent prior to the program's implementation. The program has also helped the hospital reduce the fragility fracture patients' time in the emergency department by about 7 percent and the time until they reach the operating room by 28 percent.
One important component that helps hospitals like Baptist Memorial successfully implement a fragility fracture program is gaining the buy-in, commitment, and coordination required from all participating departments. This can be difficult for some facilities where physicians are accustomed to their practice patterns and may not be enthusiastic about a new, coordinated model of care. Some hospitals have overcome these challenges by working with a clinical outsourcing partner that has experience in cooperating and working with service lines to achieve efficiencies across the continuum of care. A partner that can manage a hospital's emergency medicine, anesthesia, hospital medicine, and orthopedic surgery departments in a coordinated way would provide significant support for implementation of a fragility fracture program.
As the senior population of the United States continues to grow, fragility fractures will become more common, and hospitals with the vision to implement a program specifically designed to provide optimal care to this patient population will be at the forefront of improving health outcomes and lowering associated healthcare costs for the hospitals as well as their patients.