Geisinger High-Risk Osteoporosis Clinic: Narrowing Post-Fracture Care Gaps and Lessons Learned
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Abstract
Background: In 2008, Geisinger Rheumatology established a Fracture Liaison Service (FLS) termed HiROC (High-Risk Osteoporosis Clinic). Inpatient HiROC teams integrated with outpatient HiROC clinics.
Aim: We review the history of Geisinger HiROC, performance and lessons learned. We examine this: In a high-risk, post-fracture, drug-indicated patient without treatment contraindications, was patient treated? If a patient chose followup with Geisinger primary care physician (PCP), was that patient treated?
Results: Four Geisinger HiROC analyses are presented: 2008-2011; 2013-2015;2016; and 2017-2018. HiROC treatment rates are 80 %, 75.4 %, 74 %, and 72 %, respectively. Geisinger PCP treatment rates are 32.2 %, 13.8 %, and 14 %. (PCP data from 2017-2018 not included) 2008-2011 analysis included 888 patients, mean age 76.1, 77.6 % women and 22.4 % men. Mean 25-OH Vit. D was 25.6. Hip fractures represented 58.2 % of cohort and vertebral fractures (VF) 11.6 %. At discharge, 44.3 % went to Rehab, 31.5 % to Nursing Home (NH) and 24 % home. Six- month mortality was 14.7 % and HiROC followup 51.5 %.
2013-2015 analysis included 1279 patients with mean age of 77.8 and 74 % women, 26 % men. Hip fractures were seen in 67.6 % and VF in 6.6 % and mean 25-OH Vit. D was 25.8. Patients chose HiROC 42.6 %, 37 % HiROC patients were lost to followup, and 6 month mortality was 16 %. GHP insured 27.4 % and within GHP-insured patients, HiROC treated 74.7 % versus 19.7 % by Geisinger PCP. In 2016, we reported 380 patients, mean age 78, 69 % women, 31 % men. Hip fractures accounted for 74.5 %, VF 6.6 %, with mean 25-OH Vit.D 25.8 and 17 % six month mortality. Patients chose HiROC 46 % of time.
2017-2018 analysis included 740 patients, mean age 78, with 89 % women and 11 % men. Hip fractures accounted for 78 % and VF 6.6 %. HiROC was chosen by 45 % patients and 6-month mortality was 14 %.
Conclusions: Geisinger HiROC treated high-risk, post-fractured, drug indicated patients 72 – 80 % of time, far superior to Geisinger PCP rates of 13.8 - 32.2 %.
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