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Fracture prevention pathway in South Central

Fracture prevention pathway in South Central. Proposed patient pathway Bone treatment pathway Administration pathway. Current status: How many fractures?. 175. 360. 500. 560. 375. 400. 160. 4260 hip fractures ~12,800 non-hip fragility fractures. 600. 380. 610. 140.

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Fracture prevention pathway in South Central

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  1. Fracture prevention pathway in South Central Proposed patient pathwayBone treatment pathwayAdministration pathway

  2. Current status: How many fractures? 175 360 500 560 375 400 160 4260 hip fractures ~12,800 non-hip fragility fractures 600 380 610 140

  3. After the first fracture, act to prevent the second Fracture prevention is cost releasing

  4. Current status: How many fracture prevention services? No No 50% only Inpatient only No Inpatient only No No 100% provision of fracture Prevention services in SC No No No Inpatient only

  5. Coordinated Implementation Equitable Effective Evidence based “After the first fracture, act to prevent the second... anywhere within South Central ”

  6. OUTPATIENT FRACTURE CLINIC Secondary care Non- surgical (pelvic/ T/L #) TRAUMA Community bed/ Care home Admitted non-trauma NOF Non NOF DXA appropriate? NO YES Community clinics: FPN + GPSi Risk factors: bone + mini Falls Bloods Rx ASSESS Bone/ mini-Falls TREAT/ REFER DXA + falls triage Monitoringfor 5 years: Adherence Side effects / Re # REFERRAL

  7. Strategic Critical Success factors • To make savings in medium to long term, across the total health and social care pathway through reduction in re-admissions from recurrent fracture and falls. • To improve the quality of the experience for the individual and their family, by developing equality of access to information and management of all fragility fractures • To support best practice in the care of people who have fragility fractured

  8. Range of Targets • To reduce by 30% reduction in the re-current all fracture rate • To reduce by 50% the re-current hip fracture rate • To reduce by 50% the re-current fall rate • To reduce by 10% all fractures in the over 65 population from the predicted population growth (local target in place since April 2009) • A 20% reduction in non-conveyed falls seen by the ambulance service in patients with a previous history of fracture • Corresponding reduction in care home placements and in domiciliary packages • Reduction of patients referred to Nuffield Orthopaedic Centre, Metabolic Bone clinic and CHO Falls clinic • To improve case finding of fragility fracture patients presenting to acute care. • To increase the percentage of fragility fracture patients receiving falls and bone health assessment (questionnaire, bloods, DXA) • All individuals with a fragility fracture are put on to an individual management plan

  9. The next step • This is a big change in practice • 2 pilots for specific aspects of case finding, falls and bone assessment at JR Trauma OPD by both falls and bone health staff • Test before commissioning more widely • Propose a 6 month feasibility study • 2.0 Nurses • 0.5 Admin • Prototype database • Clear productivity, cost and quality outcome metrics…..to justify full commissioning across the region

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