Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Fung K W (1), Yu L F (1), Wong K K (1)
Affiliation :
(1) Department of Orthopaedics and Traumatology, Kwong Wah Hospital
Introduction :
Vertebral compression fracture (VCF) is the most prevalent fragility fracture in the elderly, often associated with osteoporosis and causing back pain that may require clinical admission. If left untreated, it can increase the risk of future fracture, resulting in further functional limitations and suboptimal quality of life in the elderly.
Objectives :
The Kwong Wah Hospital (KWH) Orthopaedic Unit recognized the need for an effective clinical management approach and embarked on a hospital redevelopment initiative to address these challenges.
A screening process has been implemented for every patient admitted with back pain, with suitable cases with VCF being recruited to the VCF clinical pathway for fragility fracture management. This study aims to evaluate its effectiveness.
Methodology :
The VCF pathway, started in May 2022, is evaluated based on one year of data collection from July 1,2022 until June 30, 2023.
Service outcomes were assessed with reference to the international care standards measuring the effectiveness of fracture liaison services (FLS) and providing guidance for quality improvement. Outcome measurements include rate of case identification, fracture risk assessment, fall assessment, antiosteoporotic medication (AOM) recommendation, AOM initiation, and patient follow-up adherence.etc.
Result & Outcome :
Out of 717 patients screened for back pain, 215 cases of VCF were identified. The identification rate was considered adequate compared to the number of fragility hip fracture (FHF) cases (n=246) identified during the same period.
All VCF cases (n=215) received fracture risk assessment and referred allied health professionals for fall prevention measures. During hospitalization, 90% (n=195) were assessed by an orthogeriatrician, ensuring comprehensive care.
Over 60% (n=133) were offered AOM recommendations, highlighting the proactive approach to managing osteoporosis. Among them, 70% (n=92) commenced or continued AOM within 16 weeks post index fracture, demonstrating the success of treatment initiation. Furthermore, 85% (n=111) of patients with AOM recommendation followed up within 16 weeks post sentinel fracture, indicating high patient adherence.
To conclude, the evaluation of the VCF clinical pathway at KWH has demonstrated the effectiveness of a multidisciplinary approach in managing fragility fractures. The integration of the pathway with hospital redevelopment initiatives highlights the commitment to providing high quality care, improving healthcare services and enhancing the overall patient experience, in meeting the evolving healthcare needs.
