Gondo Gaku, Shin Jung-Ho, Kunisawa Susumu, Imanaka Yuichi
Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-Cho, Sakyo-Ku, Kyoto City, Kyoto, 606-8501, Japan.
Osteoporos Int. 2025 Feb;36(2):235-244. doi: 10.1007/s00198-024-07269-0. Epub 2024 Dec 13.
In Japan, the publication of the Fracture Liaison Service Clinical Standard (FLS-CS) had no apparent effect on the implementation of secondary fracture prevention, but the introduction of a new management fee for secondary fracture prevention significantly promoted the implementation of secondary fracture prevention for the target disease.
Secondary fracture prevention is important for managing fragility fractures. In Japan, the FLS-CS was published in 2019, alongside the introduction of a new management fee for secondary fracture prevention, launched in 2022 for patients who underwent surgery for hip fracture. FLS programs were hospital-based. This study evaluated the impact of these interventions on the implementation of secondary fracture prevention during hospitalization for fragility fractures.
Using claims data from the Quality Indicator/Improvement Project database, patients aged 50 years or older with hip fracture who underwent surgery or with vertebral fractures were included. The publication of FLS-CS was the first intervention, followed by the introduction of the management fee as the second intervention. To evaluate the impact of these interventions, we performed an interrupted time series analysis separately for hip and vertebral fractures.
For hip fractures, there was no immediate change after the first intervention, and the monthly rate of change decreased (incidence rate ratio [IRR]: 0.985, 95% confidence interval [CI]: 0.979-0.991). After the second intervention, there was an immediate increase (IRR: 1.890, 1.761-2.029), and the monthly rate of change also increased (IRR: 1.050, 1.044-1.056). For vertebral fractures, the proportion of change increased only immediately after the second intervention (IRR: 1.148, 1.038-1.270).
The publication of FLS-CS had no apparent effect on the implementation of secondary fracture prevention in patients with either hip or vertebral fractures. Conversely, the introduction of the management fee had the effect of increasing that for the target disease.
在日本，《骨折联络服务临床标准》（FLS-CS）的发布对二级骨折预防的实施没有明显影响，但引入新的二级骨折预防管理费用显著促进了目标疾病二级骨折预防的实施。
二级骨折预防对于管理脆性骨折很重要。在日本，FLS-CS于2019年发布，同时引入了新的二级骨折预防管理费用，该费用于2022年针对接受髋部骨折手术的患者推出。FLS项目以医院为基础。本研究评估了这些干预措施对脆性骨折住院期间二级骨折预防实施情况的影响。
使用质量指标/改进项目数据库中的理赔数据，纳入年龄在50岁及以上接受手术的髋部骨折患者或椎体骨折患者。FLS-CS的发布是第一次干预，随后引入管理费用作为第二次干预。为了评估这些干预措施的影响，我们分别对髋部骨折和椎体骨折进行了中断时间序列分析。
对于髋部骨折，第一次干预后没有立即变化，每月变化率下降（发病率比[IRR]：0.985，95%置信区间[CI]：0.979 - 0.991）。第二次干预后，立即出现增加（IRR：1.890，1.761 - 2.029），每月变化率也增加（IRR：1.050，1.044 - 1.056）。对于椎体骨折，仅在第二次干预后立即变化比例增加（IRR：1.148，1.038 - 1.270）。
FLS-CS的发布对髋部或椎体骨折患者二级骨折预防的实施没有明显影响。相反，引入管理费用对目标疾病有增加预防实施的效果。
