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A patient-level key performance indicator set to measure the effectiveness of fracture liaison services and guide quality improvement: A position paper of the IOF Capture the Fracture Working Group, National Osteoporosis Society and Fragility Fracture Network

A patient-level key performance indicator set to measure the effectiveness of fracture liaison services and guide quality improvement: A position paper of the IOF Capture the Fracture Working Group, National Osteoporosis Society and Fragility Fracture Network
A patient-level key performance indicator set to measure the effectiveness of fracture liaison services and guide quality improvement: A position paper of the IOF Capture the Fracture Working Group, National Osteoporosis Society and Fragility Fracture Network
Summary The International Osteoporosis Foundation (IOF) Capture the Fracture® Campaign with the Fragility Fracture Network (FFN) and National Osteoporosis Foundation (NOF) has developed eleven patient-level key performance indicators (KPIs) for fracture liaison services (FLSs) to guide quality improvement. Introduction Fracture Liaison Services (FLSs) are recommended worldwide to reduce fracture risk after a sentinel fracture. Given not every FLS is automatically effective, the IOF Capture the Fracture working group has developed and implemented the Best Practice Framework to assess the organisational components of an FLS. We have now developed a complimentary KPI set that extends this assessment of performance to the patient level. Methods The Capture the Fracture working group in collaboration with the Fragility Fracture Network Secondary Fragility Fracture Special Interest Group and National Osteoporosis Foundation adapted existing metrics from the UK-based Fracture Liaison Service Database Audit to develop a patient-level KPI set for FLSs. Results Eleven KPIs were selected. The proportion of patients: with non-spinal fractures; with spine fractures (detected clinically and radiologically); assessed for fracture risk within 12 weeks of sentinel fracture; having DXA assessment within 12 weeks of sentinel fracture; having falls risk assessment; recommended anti-osteoporosis medication; commenced of strength and balance exercise intervention within 16 weeks of sentinel fracture; monitored within 16 weeks of sentinel fracture; started anti-osteoporosis medication within 16 weeks of sentinel fracture; prescribed anti-osteoporosis medication 52 weeks after sentinel fracture. The final KPI measures data completeness for each of the other KPIs. For these indicators, levels of achievement were set at the < 50%, 50–80% and > 80% levels except for treatment recommendation where a level of 50% was used. Conclusion This KPI set compliments the existing Best Practice Framework to support FLSs to examine their own performance using patient-level data. By using this KPI set for local quality improvement cycles, FLSs will be able to efficiently realise the full potential of secondary fracture prevention and improved clinical outcomes for their local populations.
Fracture Liaison Service/FLS, Key performance indicators, Osteoporosis, Quality improvement, Secondary fracture prevention
0937-941X
1193-1204
Kassim Javaid, M.
12781b29-34fa-4158-837b-daf452b8d4ed
Sami, A
b42e7704-dc68-46ef-a642-bc2a83abdfa1
Lems, W.F.
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Mitchell, P.
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Thomas, T.
a730aea1-d9bc-4561-bd76-bf43ce200861
Singer, A.
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Speerin, R.
da7f6ae8-4d6f-4a55-949f-45237a7501bf
Fujita, M.
715e3b1d-34ff-46ff-9340-1a337e48394d
Pierroz, D.D.
8c413f9c-c351-42e4-b601-e93d31f8812e
Akesson, K.
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Halbout, P.
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Ferrari, S.
6746194f-54f1-4c75-bcec-a7fcf2bc0c8b
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Kassim Javaid, M.
12781b29-34fa-4158-837b-daf452b8d4ed
Sami, A
b42e7704-dc68-46ef-a642-bc2a83abdfa1
Lems, W.F.
f9b48664-e72e-4c09-8a27-03eae2517883
Mitchell, P.
9dfcdf84-1267-4101-b30d-4c6dee09e414
Thomas, T.
a730aea1-d9bc-4561-bd76-bf43ce200861
Singer, A.
04a7fa7e-123b-453e-8f73-bcbd5d490ad4
Speerin, R.
da7f6ae8-4d6f-4a55-949f-45237a7501bf
Fujita, M.
715e3b1d-34ff-46ff-9340-1a337e48394d
Pierroz, D.D.
8c413f9c-c351-42e4-b601-e93d31f8812e
Akesson, K.
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Halbout, P.
4c9d1a54-1345-4750-89f1-3d2b82eb9042
Ferrari, S.
6746194f-54f1-4c75-bcec-a7fcf2bc0c8b
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6

Kassim Javaid, M., Sami, A, Lems, W.F., Mitchell, P., Thomas, T., Singer, A., Speerin, R., Fujita, M., Pierroz, D.D., Akesson, K., Halbout, P., Ferrari, S. and Cooper, C. (2020) A patient-level key performance indicator set to measure the effectiveness of fracture liaison services and guide quality improvement: A position paper of the IOF Capture the Fracture Working Group, National Osteoporosis Society and Fragility Fracture Network. Osteoporosis International, 31 (7), 1193-1204. (doi:10.1007/s00198-020-05377-1).

Record type: Article

Abstract

Summary The International Osteoporosis Foundation (IOF) Capture the Fracture® Campaign with the Fragility Fracture Network (FFN) and National Osteoporosis Foundation (NOF) has developed eleven patient-level key performance indicators (KPIs) for fracture liaison services (FLSs) to guide quality improvement. Introduction Fracture Liaison Services (FLSs) are recommended worldwide to reduce fracture risk after a sentinel fracture. Given not every FLS is automatically effective, the IOF Capture the Fracture working group has developed and implemented the Best Practice Framework to assess the organisational components of an FLS. We have now developed a complimentary KPI set that extends this assessment of performance to the patient level. Methods The Capture the Fracture working group in collaboration with the Fragility Fracture Network Secondary Fragility Fracture Special Interest Group and National Osteoporosis Foundation adapted existing metrics from the UK-based Fracture Liaison Service Database Audit to develop a patient-level KPI set for FLSs. Results Eleven KPIs were selected. The proportion of patients: with non-spinal fractures; with spine fractures (detected clinically and radiologically); assessed for fracture risk within 12 weeks of sentinel fracture; having DXA assessment within 12 weeks of sentinel fracture; having falls risk assessment; recommended anti-osteoporosis medication; commenced of strength and balance exercise intervention within 16 weeks of sentinel fracture; monitored within 16 weeks of sentinel fracture; started anti-osteoporosis medication within 16 weeks of sentinel fracture; prescribed anti-osteoporosis medication 52 weeks after sentinel fracture. The final KPI measures data completeness for each of the other KPIs. For these indicators, levels of achievement were set at the < 50%, 50–80% and > 80% levels except for treatment recommendation where a level of 50% was used. Conclusion This KPI set compliments the existing Best Practice Framework to support FLSs to examine their own performance using patient-level data. By using this KPI set for local quality improvement cycles, FLSs will be able to efficiently realise the full potential of secondary fracture prevention and improved clinical outcomes for their local populations.

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More information

Accepted/In Press date: 3 March 2020
e-pub ahead of print date: 8 April 2020
Keywords: Fracture Liaison Service/FLS, Key performance indicators, Osteoporosis, Quality improvement, Secondary fracture prevention

Identifiers

Local EPrints ID: 440616
URI: http://eprints.soton.ac.uk/id/eprint/440616
ISSN: 0937-941X
PURE UUID: d1a46fee-7f67-4ead-92b6-7fcba5373922
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 12 May 2020 16:35
Last modified: 26 Nov 2021 02:40

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Contributors

Author: M. Kassim Javaid
Author: A Sami
Author: W.F. Lems
Author: P. Mitchell
Author: T. Thomas
Author: A. Singer
Author: R. Speerin
Author: M. Fujita
Author: D.D. Pierroz
Author: K. Akesson
Author: P. Halbout
Author: S. Ferrari
Author: C. Cooper ORCID iD

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