Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
School of Medicine, Sydney Campus, The University of Notre Dame Australia, 140 Broadway, Sydney, NSW, 2007, Australia.
Curr Osteoporos Rep. 2019 Dec;17(6):510-520. doi: 10.1007/s11914-019-00544-8.
This review sought to describe quality improvement initiatives in fragility fracture care and prevention.
A major care gap persists throughout the world in the secondary prevention of fragility fractures. Systematic reviews have confirmed that the Fracture Liaison Service (FLS) model of care is associated with significant improvements in rates of bone mineral density testing, initiation of osteoporosis treatment and adherence with treatment for individuals who sustain fragility fractures. Further, these improvements in the processes of care resulted in significant reductions in refracture risk and lower post-fracture mortality. The primary challenge facing health systems now is to ensure that best practice is delivered effectively in the local healthcare setting. Publication of clinical standards for FLS at the organisational and patient level in combination with the establishment of national registries has provided a mechanism for FLS to benchmark and improve their performance. Major efforts are ongoing at the global, regional and national level to improve the acute care, rehabilitation and secondary prevention for individuals who sustain fragility fractures. Active participation in these initiatives has the potential to eliminate current care gaps in the coming decade.
本文旨在描述脆性骨折治疗和预防方面的质量改进措施。
在脆性骨折的二级预防方面，全世界仍存在一个主要的护理差距。系统评价证实，骨折联络服务（FLS）护理模式与骨密度检测率、骨质疏松症治疗的启动以及脆性骨折患者治疗依从性的显著改善相关。此外，这些护理流程的改进导致骨折再发风险显著降低，骨折后死亡率降低。目前，医疗体系面临的主要挑战是确保在当地医疗环境中有效实施最佳实践。在组织和患者层面发布 FLS 的临床标准，并结合国家登记处的建立，为 FLS 提供了一个基准和改进其绩效的机制。目前正在全球、区域和国家各级做出重大努力，以改善脆性骨折患者的急性护理、康复和二级预防。积极参与这些举措有可能在未来十年消除当前的护理差距。
