A 3i hip fracture liaison service with nurse and physician co-management is cost-effective when implemented as a standard clinical program

Beaupré, Lauren A; Lier, Doug; Smith, Christopher; Evens, L; Hanson, Heather; Juby, Angela; Kivi, Paul; Majumdar, Sumit R.; Team, STOP-Fracture

doi:10.1007/s11657-020-00781-w

Cited by 10 publications

(9 citation statements)

References 36 publications

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“…FLS-based management of fragility fractures had been reported to be cost-effective in Canada with the reduction of subsequent hip fractures and a net hospital cost savings ( 381 ). The implementation of hip FLS co-managed by a nurse and physician showed a $54 incremental cost/patient with a modest gain of eight QALYs/1,000 patients ( 382 ). For every 10,000 patients that participated in FLS, an additional 400 patients would be treated with bisphosphonates, resulting in the avoidance of around four hip fractures.…”

Section: Resultsmentioning

confidence: 99%

Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021

et al. 2023

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BackgroundFragility fractures are a major public health concern owing to their worrying and growing burden and their onerous burden upon health systems. There is now a substantial body of evidence that individuals who have already suffered a fragility fracture are at a greater risk for further fractures, thus suggesting the potential for secondary prevention in this field.PurposeThis guideline aims to provide evidence-based recommendations for recognizing, stratifying the risk, treating, and managing patients with fragility fracture. This is a summary version of the full Italian guideline.MethodsThe Italian Fragility Fracture Team appointed by the Italian National Health Institute was employed from January 2020 to February 2021 to (i) identify previously published systematic reviews and guidelines on the field, (ii) formulate relevant clinical questions, (iii) systematically review literature and summarize evidence, (iv) draft the Evidence to Decision Framework, and (v) formulate recommendations.ResultsOverall, 351 original papers were included in our systematic review to answer six clinical questions. Recommendations were categorized into issues concerning (i) frailty recognition as the cause of bone fracture, (ii) (re)fracture risk assessment, for prioritizing interventions, and (iii) treatment and management of patients experiencing fragility fractures. Six recommendations were overall developed, of which one, four, and one were of high, moderate, and low quality, respectively.ConclusionsThe current guidelines provide guidance to support individualized management of patients experiencing non-traumatic bone fracture to benefit from secondary prevention of (re)fracture. Although our recommendations are based on the best available evidence, questionable quality evidence is still available for some relevant clinical questions, so future research has the potential to reduce uncertainty about the effects of intervention and the reasons for doing so at a reasonable cost.

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Section: Resultsmentioning

confidence: 99%

Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021

et al. 2023

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“…Formal cost-effectiveness modeling, including calculation of ICERs, has been performed in some analyses of perioperative care pathways. 26 Markov modeling has been shown to be feasible in analysis of a postoperative care model to reduce repeat fractured neck of femur, 27 finding an ICER, using QALYs as an effect, below the standard cost-effectiveness threshold, although this study did not examine in-hospital processes and pathways. It concluded: ".a cohort simulation CEA suggested that the H-FLS was costeffective with potential to become cost-saving."…”

Section: Discussionmentioning

confidence: 98%

Cost-Effectiveness in Perioperative Care: Application of Markov Modeling to Pathways of Perioperative Care

Ludbrook

Leaman

2022

Value in Health

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This study aimed to evaluate the application of cost-effectiveness modeling to redesign of perioperative care pathways, from a hospital perspective.Methods: A Markov cost-effectiveness model of patient transition between care locations, each with different characteristics and cost, was developed. Inputs were derived from clinical trials piloting a preoperative call center and a postoperative medium-acuity care unit. The effect chosen was days at home (DAH) after surgery, reflecting quality of in-hospital care, acknowledged financially by fundholders, and relevant to consumers. Cost was from the hospital's perspective. A model cycle time of 4 hours for 30 days reflected relevant timelines and costs.Results: A Markov model was successfully created, accounting for the care locations in the 2 pathways as model states and accounting for consequences and costs. Cost-effectiveness analysis allowed the calculation of an incremental costeffectiveness ratio comparing these pathways, providing a mean incremental cost-effectiveness ratio of 2$427 per additional DAH, where incremental costs and DAH were 2$644 and 11.51, respectively. Probabilistic sensitivity analysis suggested the new pathway had a 61% probability of reduced costs and a 74% probability of increased DAH and a 58% probability this pathway was dominant. Tornado analysis revealed the major contributor to increased costs as intensive care unit stay and the major contributor to decreased costs as ward stay. For the new pathway, the probability of transfer from ward to home and the probability of staying at home had the greatest impact on DAH.Conclusions: These data suggest Markov modeling may be a useful tool for the cost-effectiveness analysis of initiatives in perioperative care.

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“…Combining FLS and OGS services into a PFC program model has reported a 2-to 5-fold improvement in outcomes, including an improvement in program enrolment, bone mineral density assessment, diagnosis, and initiation of osteoporosis therapy [7][8][9][10]. 2.…”

Section: Where Are the Cracks And How To Heal?mentioning

confidence: 99%

“…However, PFC services in Egypt is a combination of the FLS and OGS approaches. Such combined programs have reported a 2-to 5-fold improvement in outcomes, including program enrolment, osteoporosis testing and diagnosis, and early initiation of osteoporosis therapy for hip fracture patients in particular [4,[7][8][9][10][20][21][22]. The Egyptian Academy of bone health has developed an Egyptian FLS clinical standards for implementation of PFC in Egypt in agreement with the international FLS protocols.…”

Section: Pfc Economics: Cost Effectivenessmentioning

confidence: 99%

“…There is increasing evidence that increasing protein intake and progressive resistive exercise can increase muscle mass and strength [35,36]. Zhang et al 2020 [37] concluded that muscle strength and function can improve using moderate to high intensity resistance exercises [8]. However, those with perioperative hip fracture cannot immediately tolerate an exercise intervention.…”

Section: Non-pharmacological Treatment Of Osteosarcopeniamentioning

confidence: 99%

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Post-fracture care program in Egypt: merging subsequent fracture prevention and improving patients’ outcomes—an initiative by the Egyptian Academy of Bone Health

Miedany

El-Naby

Abu-Zaid

et al. 2023

Egypt Rheumatol Rehabil

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Background Despite the associated high prevalence of morbidity and mortality, osteoporotic fragility fractures remain underdiagnosed and undertreated. Furthermore, those who sustain a fragility fracture are at imminent risk of sustaining subsequent fractures. Post-fracture care (PFC) programs are systematic, coordinated care programs that recognize, evaluate, and manage older adults who sustained a fragility fracture with the goal of managing all the risk factors and preventing succeeding fractures. Main text This work was carried out to outline the PFC program adopted in Egypt and its applicability in standard clinical practice. A review of literature was conducted to identify an evidence-informed PFC strategies and protocols, which outlines the optimal manner to manage older adults living with fragility fractures. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist was used to guide the reporting of this review. Based on this, a PFC integrated model of care based on a patient-centered approach has been developed aiming to optimize the outcomes. Conclusion This manuscript described the integrated model of care adopted in Egypt to provide care for older adults presenting with fragility fractures. This will pave the way to standardize patient identification and management. Additionally, to prevent occurrence of subsequent fractures and to enhance equity of care for patients with fragility fracture and osteoporosis, expansion of such service to rural and remote areas is highly recommended.

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A 3i hip fracture liaison service with nurse and physician co-management is cost-effective when implemented as a standard clinical program

Cited by 10 publications

References 36 publications

Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021

Executive summary: Italian guidelines for diagnosis, risk stratification, and care continuity of fragility fractures 2021

Cost-Effectiveness in Perioperative Care: Application of Markov Modeling to Pathways of Perioperative Care

Post-fracture care program in Egypt: merging subsequent fracture prevention and improving patients’ outcomes—an initiative by the Egyptian Academy of Bone Health

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