Hofflich Heather L, Oh Deborah K, Choe Charles H, Clay Brian, Tibble Courtney, Kulasa Kristi M, Shah Priya K, Fink Edward, Girard Paul J, Schwartz Alexandra K, Maynard Gregory A
Jt Comm J Qual Patient Saf. 2014 May;40(5):228-34. doi: 10.1016/s1553-7250(14)40030-8.
Nearly 2 million osteoporosis-related fractures occur yearly in the United States, with more than 400,000 requiring hospital admissions. Fewer than 30% receive proper evaluation and care for osteoporosis, representing a large opportunity to enhance secondary prevention of fractures. Methods to improve identification and triage of hospitalized fragility-fracture patients are desirable.
A multidisciplinary team was created, and definitions were established for an evidence-based best-practice protocol to assess, treat, and document an osteoporosis diagnosis and triage patients with hip-fragility fractures on the basis of the best-practice recommendations from The Joint Commission and the National Osteoporosis Foundation. The team initiated a preauthorized osteoporosis consultation from the endocrinology service for hip-fracture patients, "triggered" via a brief query in admission orders or by the orthopedic service nurse practitioner. Osteoporosis consultations used a consultation template reflecting the protocol.
Data were analyzed for 71 baseline patients and 61 intervention patients. The groups possessed similar age, gender, race, and body mass index characteristics. The baseline (on-demand consultation) group suffered from poor performance, with only 3%-21% of patients receiving the desired evaluation, documentation, treatment, or outpatient follow-up. Intervention (triggered-consultation) patients improved markedly postintervention, With performance increasing by 52%-76% on all parameters except outpatient follow-up, which changed insignificantly (6%-15%).
Although triggered consultation was effective, multimodal layered interventions may achieve even better results and address several identified barriers.
在美国，每年有近200万例与骨质疏松症相关的骨折发生，其中超过40万例需要住院治疗。接受骨质疏松症适当评估和治疗的患者不到30%，这意味着在加强骨折二级预防方面有很大的机会。因此，需要改进识别和分流住院脆性骨折患者的方法。
成立了一个多学科团队，并根据联合委员会和国家骨质疏松症基金会的最佳实践建议，制定了基于证据的最佳实践方案的定义，以评估、治疗和记录骨质疏松症诊断，并对髋部脆性骨折患者进行分流。该团队为髋部骨折患者启动了一项由内分泌科提供的预先授权的骨质疏松症咨询服务，通过入院医嘱中的简短询问或骨科服务护士从业者来“触发”。骨质疏松症咨询使用了反映该方案的咨询模板。
对71例基线患者和61例干预患者的数据进行了分析。两组在年龄、性别、种族和体重指数特征方面相似。基线（按需咨询）组表现不佳，只有3%-21%的患者接受了所需的评估、记录、治疗或门诊随访。干预（触发咨询）患者在干预后有显著改善，除门诊随访外，所有参数的表现均提高了52%-76%，而门诊随访的变化不显著（6%-15%）。
虽然触发咨询是有效的，但多模式分层干预可能会取得更好的效果，并解决一些已发现的障碍。
