Abstract
Introduction: Fracture liaison services (FLS) aim to prevent secondary fractures by promptly identifying patients above 50 years with fragility fractures. The standard recommendation by FLS Database (FLS-DB) is to identify 80% expected fragility fractures, commencing treatment for 50% and monitor 80% at 52 weeks.
Methods: A quality improvement methodology based on the model of improvement; Plan-Do-Study-Act (PDSA) cycles was introduced in 2022. The fragility fracture case identification increased from 22.7% (2021) to 41.1% (2022) and 58.4% in 2023, a 149% increase. Process mapping for the Aneurin Bevan FLS (AB-FLS) showed that follow-up clinics were only ad-hoc and not formalised. A separate clinic code for annual review of patients, led by Speciality Geriatric Trainee was tested in 2023. One-year follow-up clinic streamlined service and improved performance to 25.9% (360 cases) in 2023, just above the national benchmark (24.2%).
Our objective is to introduce multi-stakeholder involvement to further improve and sustain 52-weeks follow-up improvement to meet the service demand and national target.
Results: Multiple PDSA cycles led to AB-FLS Quality Assurance group including clinicians, Pharmacist, Primary Care General Practitioner as Influencers and three Patient Representatives. Team met formally every 3 months to review interventions and introduce changes. Challenges were overcome by providing a dedicated 52-weeks follow-up clinic. In addition, engagement with Primary Care for longer-term osteoporosis care unless requiring specialist bone health reviews is ongoing.
In 2024, AB-FLS identified 2620 cases (70%; National benchmark=39.9%) and commenced bone treatment for 1611 cases (61.5%; National Benchmark=56.4%). The 52-weeks follow-up improved from 25.9% (360 cases) in 2023 to 62.7% (1010 cases) in 2024, which is more than double the national benchmark (24.2%)
Conclusion: This work is aligned with Welsh Prudent Healthcare principles of evidence-based medicine, partnership working with patients and meeting the unmet needs of the most vulnerable. Collaborative efforts with diverse stakeholders including primary care and patient representative have improved 52-week follow-up in 62% fracture patients. The success of this multi-stakeholder quality initiatives offers compelling evidence that this model is scalable across Wales, providing a sustainable and impactful solution to managing osteoporosis and preventing secondary fractures.
Comments
This is an excellent and…
This is an excellent and practical initiative. A multi-stakeholder approach is crucial when aiming to enhance long-term follow-up and adherence to care pathways in fracture prevention. Building on existing quality initiatives and aligning with FLS-DB (Fracture Liaison Service Database) guidance can help ensure consistency, accountability, and better patient outcomes over the 52-week period. Your emphasis on collaboration between clinicians, coordinators, and health systems highlights how shared responsibility can lead to sustained improvements in secondary fracture prevention. A well-structured and forward-thinking effort toward comprehensive osteoporosis care.
Nice work keep going
This abstract showcases a highly successful multi-stakeholder quality improvement effort!
The massive 149% increase in fragility fracture case identification and the impressive leap in 52-week follow-up completion from 25.9% to 62.7% (more than double the national benchmark) demonstrates highly impactful and sustainable results achieved through collaborative, evidence-based service redesign. This is a commendable model for scaling across the region
A strong, collaborative approach that
A strong, collaborative approach that smartly builds on existing quality initiatives. By aligning stakeholders around FLS-DB guidance, this project shows clear potential to enhance 52-week follow-up, reduce variation, and drive sustained improvement in patient outcomes across fracture services.