Reducing the gap between best practice and usual care of fragility fractures

2007 ◽  
Vol 3 (6) ◽  
pp. 315-315
Keyword(s):  
Usual Care ◽  
Best Practice ◽  
Fragility Fractures

scholarly journals Protocol for a two-arm pragmatic stepped-wedge hybrid effectiveness-implementation trial evaluating Engagement and Collaborative Management to Proactively Advance Sepsis Survivorship (ENCOMPASS)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marc Kowalkowski ◽  
Tara Eaton ◽  
Andrew McWilliams ◽  
Hazel Tapp ◽  
Aleta Rios ◽  
...  
Keyword(s):  
Usual Care ◽  
Best Practice ◽  
Healthcare Delivery ◽  
Collaborative Management ◽  
High Morbidity ◽  
Type I ◽  
Stepped Wedge ◽  
Sepsis Management ◽  
Sepsis Survivors ◽  
Sepsis Care

Abstract Background Sepsis survivors experience high morbidity and mortality, and healthcare systems lack effective strategies to address patient needs after hospital discharge. The Sepsis Transition and Recovery (STAR) program is a navigator-led, telehealth-based multicomponent strategy to provide proactive care coordination and monitoring of high-risk patients using evidence-driven, post-sepsis care tasks. The purpose of this study is to evaluate the effectiveness of STAR to improve outcomes for sepsis patients and to examine contextual factors that influence STAR implementation. Methods This study uses a hybrid type I effectiveness-implementation design to concurrently test clinical effectiveness and gather implementation data. The effectiveness evaluation is a two-arm, pragmatic, stepped-wedge cluster randomized controlled trial at eight hospitals in North Carolina comparing clinical outcomes between sepsis survivors who receive Usual Care versus care delivered through STAR. Each hospital begins in a Usual Care control phase and transitions to STAR in a randomly assigned sequence (one every 4 months). During months that a hospital is allocated to Usual Care, all eligible patients will receive usual care. Once a hospital transitions to STAR, all eligible patients will receive STAR during their hospitalization and extending through 90 days from discharge. STAR includes centrally located nurse navigators using telephonic counseling and electronic health record-based support to facilitate best-practice post-sepsis care strategies including post-discharge review of medications, evaluation for new impairments or symptoms, monitoring existing comorbidities, and palliative care referral when appropriate. Adults admitted with suspected sepsis, defined by clinical criteria for infection and organ failure, are included. Planned enrollment is 4032 patients during a 36-month period. The primary effectiveness outcome is the composite of all-cause hospital readmission or mortality within 90 days of discharge. A mixed-methods implementation evaluation will be conducted before, during, and after STAR implementation. Discussion This pragmatic evaluation will test the effectiveness of STAR to reduce combined hospital readmissions and mortality, while identifying key implementation factors. Results will provide practical information to advance understanding of how to integrate post-sepsis management across care settings and facilitate implementation, dissemination, and sustained utilization of best-practice post-sepsis management strategies in other heterogeneous healthcare delivery systems. Trial registration NCT04495946. Submitted July 7, 2020; Posted August 3, 2020.

scholarly journals The Evaluation of an Osteoporosis Clinic in a Community Hospital Setting: a Retrospective Chart Review and Telephone Survey

2019 ◽  
Vol 22 (3) ◽  
pp. 143-147
Author(s):  
Timothy S.H. Kwok ◽  
Natasha Gakhal ◽  
Thanu N. Ruban
Keyword(s):  
Usual Care ◽  
Community Hospital ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
Fragility Fractures ◽  
Fracture Prevention ◽  
Care Group ◽  
Secondary Fracture ◽  
Set Up ◽  
Osteoporosis Clinic

BackgroundPatients who have suffered fragility fractures are at an in-creased risk for subsequent fractures. The Osteoporosis (OP) Clinic at Markham Stouffville Hospital (MSH) was set up in July 2015 to screen, diagnose, and treat patients with fragility fractures. The goal of this study was to identify differences in OP screening and treatment initiation between patients seen in the OP clinic versus usual care.MethodsA retrospective cohort study and telephone interview was conducted on 40 patients who had sustained a hip fragility fracture between September 2015 and July 2016. 20 of those patients were referred to the OP clinic, while the remaining patients received usual care. ResultsAt the end of the intervention, 16/20 patients in the OP clinic group were appropriately placed on a bisphosphonate/RANKL inhibitor versus only 6/20 patients in the usual care group (p < .01).ConclusionsA significant care gap exists in secondary fracture prevention between the osteoporosis clinic and usual care groups. Better screening and subsequent intervention are needed for patients with fragility fractures. This study highlights the efficacy of an outpatient OP clinic in a community hospital setting.

scholarly journals Best Practice Framework of Fracture Liaison Services in Spain and their coordination with Primary Care

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
A. Naranjo ◽  
S. Ojeda ◽  
M. Giner ◽  
M. Balcells-Oliver ◽  
L. Canals ◽  
...  
Keyword(s):  
Primary Care ◽  
Continuity Of Care ◽  
Performance Indicators ◽  
Best Practice ◽  
Fragility Fractures ◽  
Fracture Liaison Services ◽  
And Performance ◽  
Practice Framework ◽  
Fracture Liaison

Abstract Summary The coordination of Fracture Liaison Services (FLS) with Primary Care (PC) is necessary for the continuity of care of patients with fragility fractures. This study proposes a Best Practice Framework (BPF) and performance indicators for the implementation and follow-up of FLS-PC coordination in clinical practice in Spain. Purpose To develop a BPF for the coordination of FLS with PC in Spain and to improve the continuity of care for patients with fragility fractures. Methods A Steering Committee selected experts from seven Spanish FLS and related PC doctors and nurses to participate in a best practice workshop. Selection criteria were an active FLS with an identified champion and prior contact with PC centres linked to the hospital. The main aim of the workshop was to review current FLS practices in Spain and their integration with PC. A BPF document with processes, tools, roles, and metrics was then generated. Results Spanish FLS consists of a multidisciplinary team of physicians/nurses but with low participation of other professionals and PC staff. Evaluation and treatment strategies are widely variable. Four desired standards were agreed upon: (1) Effective channels for FLS-PC communication; (2) minimum contents of an FLS clinical report and its delivery to PC; (3) adherence monitoring 3 months after FLS baseline visit; and (4) follow-up by PC. Proposed key performance indicators are (a) number of FLS-PC communications, including consensus protocols; (b) confirmation FLS report received by PC; (c) medical/nursing PC appointment after FLS report received; and (d) number of training sessions in PC. Conclusions The BPF provides a comprehensive approach for FLS-PC coordination in Spain, to promote the continuity of care in patients with fragility fractures and improve secondary prevention. The implementation of BPF recommendations and performance indicator tracking will benchmark best FLS practices in the future.

Fragility fractures: proposal of the best practice through the fracture coordination units: the experience of Mexico

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Lucía Méndez-Sánchez ◽  
Mónica Caló ◽  
Muhammad Kassim Javaid ◽  
Grushenka Aguilar ◽  
Andrea Olascoaga-Gómez de León ◽  
...  
Keyword(s):  
Best Practice ◽  
Fragility Fractures

scholarly journals Multifaceted guideline implementation strategies improve early identification and management of osteoporosis

2009 ◽  
Vol 33 (3) ◽  
pp. 423 ◽  
Author(s):  
Cheryl M Kimber ◽  
Karen A Grimmer-Somers
Keyword(s):  
Early Identification ◽  
Best Practice ◽  
Guideline Implementation ◽  
Implementation Strategies ◽  
Fragility Fractures ◽  
Management Approach ◽  
Routine Practice ◽  
Patient Records ◽  
Fracture Management ◽  
Metropolitan Hospital

Background: Osteoporosis contributes significantly to fractures, subsequent disability and premature mortality in Australia. Better detection and management of osteoporosis will reduce unnecessary health expenditure. Objective: To evaluate, in one large tertiary metropolitan hospital, the orthopaedic health care team?s approach to osteoporosis guideline implementation to improve early identification and management of osteoporosis. Methods: This paper describes the implementation of multifaceted strategies to improve healthpromoting behaviours and the uptake of osteoporosis guidelines by staff in the orthopaedic outpatient clinic at one metropolitan hospital, reflecting organisational and individual commitment to embedding guideline recommendations into routine practice. Implementation strategies were aimed at the requirements and perspectives of different stakeholder groups. Five audit datasets were compared: 62 patient records in two baseline audits, and three post-implementation audits of 31 patient records, collected over the following 3-month periods (August 2006 to April 2007). All audits used the same criteria to assess compliance with clinical guidelines, and outcomes of implementation strategies. Results: There was consistent improvement in compliance with osteoporosis guidelines over the audit periods. Comparing baseline and immediate post-implementation data, there was a significant improvement (P < 0.05) in the percentage of patients with likely fragility fractures who were identified with an osteoporotic fracture. The percentage of patients who had a likely fragility fracture, with whom staff communicated about their problems and how to deal with them, increased consistently over all post-implementation audit periods. For patients with established osteoporosis who presented with fragility fractures, there was sustained improvement over the audit periods in the percentage provided with guideline-based care. Conclusion: This study highlights that appropriate and targeted intervention strategies can be effective if modelled on best practice guideline implementation approaches with the use of a coordinated post-fracture management approach to osteoporosis.

scholarly journals Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN’ (REGAIN): a structured summary of a study protocol for a randomised controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Gordon McGregor ◽  
Harbinder Sandhu ◽  
Julie Bruce ◽  
Bartholomew Sheehan ◽  
David McWilliams ◽  
...  
Keyword(s):  
Mental Health ◽  
Usual Care ◽  
Hospital Discharge ◽  
Best Practice ◽  
Mental Health Problems ◽  
Controlled Trial ◽  
Rehabilitation Programme ◽  
Home Based ◽  
Full Protocol ◽  
At Home

Abstract Objectives The primary objective is to determine which of two interventions: 1) an eight week, online, home-based, supervised, group rehabilitation programme (REGAIN); or 2) a single online session of advice (best-practice usual care); is the most clinically and cost-effective treatment for people with ongoing COVID-19 sequelae more than three months after hospital discharge. Trial design Multi-centre, 2-arm (1:1 ratio) parallel group, randomised controlled trial with embedded process evaluation and health economic evaluation. Participants Adults with ongoing COVID-19 sequelae more than three months after hospital discharge Inclusion criteria: 1) Adults ≥18 years; 2) ≥ 3 months after any hospital discharge related to COVID-19 infection, regardless of need for critical care or ventilatory support; 3) substantial (as defined by the participant) COVID-19 related physical and/or mental health problems; 4) access to, and able/supported to use email and internet audio/video; 4) able to provide informed consent; 5) able to understand spoken and written English, Bengali, Gujarati, Urdu, Punjabi or Mandarin, themselves or supported by family/friends. Exclusion criteria: 1) exercise contraindicated; 2) severe mental health problems preventing engagement; 3) previous randomisation in the present study; 4) already engaged in, or planning to engage in an alternative NHS rehabilitation programme in the next 12 weeks; 5) a member of the same household previously randomised in the present study. Intervention and comparator Intervention 1: The Rehabilitation Exercise and psycholoGical support After covid-19 InfectioN (REGAIN) programme: an eight week, online, home-based, supervised, group rehabilitation programme. Intervention 2: A thirty-minute, on-line, one-to-one consultation with a REGAIN practitioner (best-practice usual care). Main outcomes The primary outcome is health-related quality of life (HRQoL) – PROMIS® 29+2 Profile v2.1 (PROPr) – measured at three months post-randomisation. Secondary outcomes include dyspnoea, cognitive function, health utility, physical activity participation, post-traumatic stress disorder (PTSD) symptom severity, depressive and anxiety symptoms, work status, health and social care resource use, death - measured at three, six and 12 months post-randomisation. Randomisation Participants will be randomised to best practice usual care or the REGAIN programme on a 1:1.03 basis using a computer-generated randomisation sequence, performed by minimisation and stratified by age, level of hospital care, and case level mental health symptomatology. Once consent and baseline questionnaires have been completed by the participant online at home, randomisation will be performed automatically by a bespoke web-based system. Blinding (masking) To ensure allocation concealment from both participant and REGAIN practitioner at baseline, randomisation will be performed only after the baseline questionnaires have been completed online at home by the participant. After randomisation has been performed, participants and REGAIN practitioners cannot be blind to group allocation. Follow-up outcome assessments will be completed by participants online at home. Numbers to be randomised (sample size) A total of 535 participants will be randomised: 263 to the best-practice usual care arm, and 272 participants to the REGAIN programme arm. Trial Status Current protocol: Version 3.0 (27th October 2020) Recruitment will begin in December 2020 and is anticipated to complete by September 2021. Trial registration ISRCTN:11466448, 23rd November 2020 Full protocol The full protocol Version 3.0 (27th October 2020) is attached as an additional file, accessible from the Trials website (Additional file 1). In the interests of expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines.

470 Financial and Efficacy Analysis of a Centralised Neck of Femur Fracture Service

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
V Ngo ◽  
G Chan ◽  
M Edmondson
Keyword(s):  
Best Practice ◽  
Financial Incentive ◽  
Statistical Tests ◽  
Osteoporotic Fractures ◽  
Fragility Fractures ◽  
University Hospitals ◽  
Neck Of Femur ◽  
Efficacy Analysis ◽  
Set Up ◽  
Neck Of Femur Fracture

Abstract Aim Osteoporotic fractures are rising in incidence, costing the National Health Service up to £1.1 billion for hospital care. The implementation of the Best Practice Tariff (BPT) of fragility fractures in 2010 created a financial incentive to achieve standards of best practice. In June 2015, a dedicated hip fracture unit (HFU) was set up at Princess Royal Hospital (PRH). The aim of this study is (A) to assess changes in performance to the BPT after the introduction of a dedicated HFU, and (B) whether the performance of a HFU is affected by direct/indirect presentation to the HFU. Method The performance of Brighton and Sussex University Hospitals (BSUH) to BPT pre and post HFU was assessed by a retrospective review of BPT performance data between 2015 and 2016. 870 patients who were treated for NOFF at BSUH were reviewed to assess whether the performance of the HFU was impacted by patients presenting either directly (PRH) to the HFU or indirectly (presentation to Royal Sussex County Hospital). Appropriate statistical tests were used to analyse the significant differences between these outcome measures. Results The comparison between pre and post HFU showed there was a significant increase in the time between A&E admission to ward, theatre or orthogeriatric (OG) assessment (P &lt; 0.001) in patients presenting indirectly to HFU compared to direct presentations. Conclusions Having a HFU is cost neutral, and advantages of HFU include focusing NOFF care which improves in patient care. BPT achievements could be improved by increasing the direct admission of NOFF to the HFU.

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