Osteoporosis Management: Strategies to Improve Patient Care Following a Fragility Fracture

Problem: A care gap exists in osteoporosis management (OPM) in females 50+ who have had a fragility fracture (FF). Clinical guidelines recommend prescribing anti-OP medications after a FF, though this recommendation is not commonly followed. The purpose of this needs assessment quality improvement project was to determine current rates of OPM at an urban university academic family and internal medicine clinic and to develop evidence-based practice OPM improvement strategies to address any identified care gap in older adult female patients who sustained a FF. Methods: This quality improvement project was designed to assess adherence to evidence-based practice guidelines for OPM using a Healthcare Effectiveness Data and Information Set (HEDIS) measure. The OPM HEDIS measure addresses females "who suffered a fracture and who had either a bone mineral density test or a prescription for a drug to treat osteoporosis six months after the fracture." A data retrieval algorithm was developed to evaluate the electronic health record. The team used a checklist to evaluate the current levels of adherence to the OPM HEDIS measure. Next, a retrospective electronic health record chart review was conducted, including female patients who had a fracture in a 4-year period, from 2017-to 2021, were aged 65-85 and had a primary care provider (PCP) at the family and internal medicine clinic. Data was analyzed, then the findings and recommendations were presented to the stakeholders. Feedback was obtained from the stakeholders about feasibility, usability, and satisfaction with the project. Results: Nineteen patients in family medicine and 11 patients in internal medicine were seen in the university hospital system for a FF. One patient was prescribed an anti-OP medication of the 16 patients in family medicine who saw their PCP after the fracture. Of the nine patients in internal medicine who saw their PCP after the fracture, none were prescribed an anti-OP medication. Bone density scans were ordered for 27% of patients in FM and no patients in IM. Conclusion: A care gap exists in OPM after a FF in this university-based family and internal medicine clinic. Several recommendations were made to improve the rate of anti-OP medications prescribed after a FF in females ≥ 65 years of age. Clinic providers were overwhelmingly supportive of moving forward with EBP OPM improvement strategies, particularly ones that was clinic-driven.