Capture the Fracture: Overview

A global campaign for the secondary prevention of

fractures by facilitating the implementation of

Fracture Liaison Services (FLS)

Professor Cyrus Cooper, MA, DM, FRCP, FFPH, FMedSciDirector & Professor of Rheumatology, MRC Lifecourse Epidemiology Unit; Vice Dean, Faculty of Medicine, University of Southampton; and Professor of Musculoskeletal Science, University of Oxford.

Acknowledgements

Capture the Fracture Steering Committee:•Prof Kristina Åkesson, Chair Capture the Fracture, Skåne University Hospital SWE•Prof Cyrus Cooper, Chair IOF Committee of Scientific Advisors, MRC Lifecourse Epidemiology Unit, University of Southampton & University of Oxford UK•Dr Alastair McLellan, Gardiner Institute Western Infirmary UK •Paul Mitchell, Synthesis Medical Limited NZL•Dr Kassim Javaid, University of Oxford UK•Judy Stenmark, Chief Executive Officer, IOF•Dr Dominique Pierroz, Science Manager, IOF•Carey Kyer, Capture the Fracture Coordinator, IOF•Dr Muriel Schneider, Capture the Fracture Coordinator, IOF

With additional support from•Charlotte Moss, MRC Lifecourse Epidemiology Unit, University of Southampton UK

Capture the Fracture

• The need for secondary fracture prevention • The Capture the Fracture campaign• How to get involved• Initial results

Effectiveness of secondary fracture prevention

Adapted from Brankin E, et al. Curr Med Res Opin 2005;21:4:475-482

Post-menopausal women 11.1 million

0.2 million

Post-menopausal women with newfracture each year

3.4 million

Post-menopausal women with osteoporosis

1.8 million

Post-menopausal women with priorfracture history

50% of hip fractures from

16% of the population

50% of hip fractures from

84% of the population

Amongst post-menopausal women, the majority of the population have not suffered fragility fractures. Case-finding strategies prioritising assessment of women with prior

fracture could identify 50% of potential hip fracture cases from 16% of the population

Amongst post-menopausal women, the majority of the population have not suffered fragility fractures. Case-finding strategies prioritising assessment of women with prior fracture could identify 50% of potential hip fracture cases from 16% of the population

• Systematic review of the literature (48 studies)

• Programmes used in clinical settings to facilitate guideline-based osteoporosis care following a fragility fracture

• Key components:• Dedicated coordinator• BMD provision• Physician and patient education• Patient follow-up within programme• Implementation audit• Economic analysis

Coordinator-based systems for secondary prevention of fragility fracture

A Report of the IOF CSA Fracture Working Group

Marsh D et al Osteop Int 2011; 22: 2051-65

Campaign structure to facilitate the implementation of Fracture Liaison Services (FLS)

• Best Practice Framework • Best Practice Recognition/application • Showcase of Best Practices/map

• Mentorship programme• Implementation guides & toolkits• Facilitated grant support

• Website www.capturethefracture.org• Resources• Communication/marketing • Coalition of partners

Set StandardsSet Standards

Facilitate Change

Facilitate Change

Create Awareness

Create Awareness

Main Programme

Purpose of the Best Practice Framework

13 internationally recognized & endorsed standards of care for secondary fracture prevention

1.Set the standard for FLS2.Assign quality level3.Benchmarking of global

service delivery

Standard Level 1 Level 2 Level 31.Patient Identification

Patients ID’d, not tracked

Patients ID’d, are tracked

Patients ID’d, tracked &Independent review

2.Patient Evaluation 50% assessed 70% assessed 90% assessed

3.Post Fracture Assessment Timing

Within 13-16 weeks Within 9-12 weeks Within 8 weeks

4.Vertebral Fracture (VF)

Known VF assessed Routinely assesses for VF

Radiologists identify VF

5.Assessment Guidelines

Local Regional National

6.Secondary Causes 50% of patients screened

70% of patients screened

90% of patients screened

7.Fall Prevention Services

50% of patients evaluated

70% of patients evaluated

90% of patients evaluated

8.Multifaceted assessment

50% of patients screened

70% of patients screened

90% of patients screened

9.Medication Initiation

50% of patients initiated

70% of patients initiated

90% of patients initiated

10.Medication Review

50% assessed 70% assessed 90% assessed

11.Communication Strategy

Communicates to doctor

Communicates to doctor w/ %50 criteria

Communicates to doctor w/ %90 criteria

12.Long-term Management

1 year follow-up 6 month follow-up & 1 year follow-up

13.Database Local Regional National

13 standards 5 categories 1 star

Fragility fracture categories

Achievement & valuation

1. Hip2. Inpatient3. Outpatient4. Vertebral5. Organizational

= 1

= 0.5

= 0.25

= 0

FLS Overall summary profile

Star Grade Calculation Score Map recognition

Hip Inpt OPD Vert Org

1+1+1+0.25+0.5 3.75

3.75

The Process

Step 1FLS submits online application

Step 2FLS entered on global map while being reviewed

Step 3BPF achievement level assigned

Step 4FLS is scored and recognized on the map

51 complete

29 in review

8 19 24

80 FLS80 FLS

Algeria Australia Belgium Brazil Bulgaria Canada China Czech Republic Finland France Greece India Ireland Italy Netherlands New Zealand Portugal Singapore Spain Sweden Switzerland Taiwan Trinidad & Tobago UK USA

Current mapping of FLS services

NEW! CtF toolkit

When?Available by the end of November 2014

What is it?A guide to facilitate the implementation of FLS worldwide

For whom?HCPs, health administrators, policymakers

Get Involved

• Visit www.capturethefracture.org to: Get mapped – Submit your FLS Join the coalition Sign up for the newsletter

• Be Active: Advocate for FLS implementation Encourage existing FLS to participate in Capture the Fracture Spread the word about FLS

Providers, politicians & patients drive change

capturethefracture@iofbonehealth.org

www.capturethefracture.org