FLS status update - Henry Mace
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FLS status update
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FLS status update - Henry Mace
- 2. National Osteoporosis Society Priorities and Plans for 2017 Aim 1: Every person aged over 50 who breaks a bone is assessed for osteoporosis and managed appropriately. Priority 1: Extend coverage of Fracture Liaison Services Priority 2: Improve quality of Fracture Liaison Services and osteoporosis services
- 3. NOS Activity – Intervention Type Englan d NI & IOM Scotlan d Wales UK New Service Development 56 1 2 7 66 Quality Improvement – Commissioning 36 5 1 1 43 Quality Improvement – Peer Support 23 1 12 6 42 Early Engagement 20 0 1 2 23 Total 135 7 16 16 174
- 4. 4 Service Improvement - Commissioning England NI & IOM Scotlan d Wales UK New Services 13 0 1 3 17 Existing Service Enhanced 6 0 0 0 6 Total 19 0 1 3 23
- 5. 5 New Services - Value England Scotland Wales UK Total population covered 4,201,867 300,410 962,188 5,464,465 Hip fractures prevented* 1,482 102 348 1,932 Gross benefit of all fractures prevented* £29,841,50 0 £1,995,00 6 £6,772,36 2 £38,608,86 8 *Over 5 years Figures based on 17 new service NOS has helped commissioned
- 6. 6 No. Standard Rationale 1 IDENTIFICATION All patients aged 50 years and over with a new fragility fracture or a newly reported vertebral fracture will be systematically and proactively identified. Patients who have sustained a fracture are at higher relative risk of fracture than those who have not. Targeted interventions in this population will have most impact on reducing the future fracture burden. FLS Clinical Standards – Standard 1
- 7. 7 To conduct an evaluation of provision for the systematic identification of newly reported vertebral fractures in patients aged over 50 at FLS sites across the UK. Objectives
- 8. 8 • 78 sites in the UK • Measure of existing service vs clinical standards • Systematic identification of vertebral fractures • Opportunistic & Presenting search Method
- 9. 9 Table of Results Country Number of Services Full Identificatio n Partial Identificatio n No Identificatio n Wales 16 1 10 5 England and NI 46 1 7 (2 intention) 36 Scotland 16 6 2 8 Totals 78 8 21 49 % 100% 10% 27% 63%
- 10. 10 IN SUMMARY 78 Sites -GAP ANALYSIS • 10% Systematically Identifying Vertebral fractures • 27% Partial (2 HAVE AN INTENTION TO START) • 63% Nothing
- 11. 11 Steps in the right direction • NOS and Clinical Specialist collaboration • Establish correct terminology • Education to identify VFX indications • Education across services e.g. radiology, primary and secondary care • Pathway development Guidance Launch May 2017 roll out of guidance by the NOS through collaboratively working with service providers.
Editor's Notes
- Refresh why we are here
- New Service Development - Implementation of FLS where none currently exists QI Commissioning - Main outcome will be enhancing an existing service through commissioning additional resource. Peer support and advice for service efficiencies are still provided to the site (as with QI - Peer Support only), but these are not the main interventions QI – Peer Support - Peer support and advice for service efficiencies are the main interventions Early Engagement - Recognises a degree of contact but little formal work planning * Probably a few sites left in the NE that we have not yet had any engagement with
- New Service - A new FLS which has been commissioned from scratch (ie. there was no FLS activity already taking place) since the start of the FLS Work Programme. - NOS has played a significant part in writing the business case or ‘implementing’ where the main input is supporting new staff and local pathways. Existing Service Enhanced – An existing FLS which has been improved (ie. through commissioning more staffing establishment to identify or manage more patients, or improve the quality of their intervention) since the start of the FLS Work Programme. - NOS has played a significant part in writing the business case or ‘implementing’ where the main input is supporting new staff and local pathways.
- Total population covered - Estimated total population covered by provision of new services only, since the beginning of FLS work programme (November 2014) Hip fractures prevented - Estimated number of hip fractures prevented (over 5 years) by provision of new services only, since the beginning of the FLS work programme (November 2014) Gross benefit of all fractures prevented - Estimated total gross benefit of all fractures prevented (over 5 years) by provision of new services only, since the beginning of the FLS work programme (November 2014)
- The first standard asserts that all patients over 50 years with a newly reported vertebral fracture will be systematically and proactively identified. Good conversations at the summit led us to undertake an audit in the VFI with the FLSs we have been working with A woman with one vertebral fracture has a 4.4 times increased risk of another vertebral fracture and 2.3 times increased risk of hip fracture 80% preventable with treatment
- Our Objective for this abstract was to conduct an evaluation to of provision for the systematic identification of newly reported vertebral fractures across the UK .
- How di we do this We looked at 78 sites across the U.K. using a gap analysis tool. The Gap Compares the existing Service against the clinical standards for FLS set out in the guidelines We asked each service if they were conducting systematic searches for presenting and opportunistic vertebral fractures. Opportunistic searching can be done from CT/MRI or x-ray that also includes the spine but may not have been the primary request, e.g. a staging CT for Malignancy. as well as those patients presenting for Spinal x ray. This maximises the ability to capture all vertebral fractures.
- Thank you to all the sites that supported this evaluation and the team Full Identification – Services looking at Presenting Spine compliant and Opportunistic Screening of other scans such as CT MRI etc Partial Identification - were those services that were systematically screening imaging – Frequently Spine X-ray – for osteoporotic Fractures but not opportunistically screening
- Overall it’s encouraging the to see how many partial services exist and we know from discussions with our clinicans and services this is an areas they wish to include or improve. Partial – not screen for opportunistic VF Why is it important ……
- Having listened to the specialist and the services out there we are working with them to try and develop and national strategy to correct this position. Work has started to Establish the correct terminology Set down indications for investigation Engage and address the needs across the services that see these patients. This includes both prevalence and incidenc but also cost both to QOL and economic cost Develop the pathway for best practice and best patient care.