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A PFC Program can Help Address Gaps in Care

What Is a Post-Fracture Care Program?

Post-Fracture Care (PFC) programs, such as fraction liaison services (FLS), systematically identify, diagnose, treat, and manage patients with osteoporosis.1,2

  • Intended to identify, investigate, and intervene with appropriate treatment for patients who are at high risk for secondary fractures because of compromised bone health3
  • Help improve health outcomes by reducing the patient risk of future fractures, which can help reduce costs to the healthcare system1-3
  • Establish processes and use guidelines for patient screening and diagnosing3
Click here to explore existing PFC Programs

Benefits of a PFC Program

After an osteoporosis-related fracture, postmenopausal women are 5 times more likely to suffer another fracture within the first year, and the risk remains elevated over time.4,* Additionally, subsequent fractures lead to increased medical costs compared to an initial fracture.5,† A PFC program can help ensure care delivery across care sites while improving health outcomes and reducing system costs.1,2

A PFC program such as an FLS can also help achieve recommended standards of care for fragility fractures and align with certain key performance indicators to guide quality improvement.1,2,6

osteoprosis-evaluationOsteoporosis evaluation
intervention-osteoporosisIntervention for osteoporosis
secondary-fracture-preventionSecondary fracture prevention

Helpful resources including tips and considerations for starting a PFC program at your institution

Establish an FLS
The 5 W's of an FLS

A PFC program such as a fracture liaison service (FLS), which assists in identifying and managing patients after a fracture, can help deliver appropriate post-fracture assessment and treatment2

*Data represent a population-based study of 4,140 postmenopausal women aged 50-80 years.

†Data based on a retrospective claim-based study, which assessed 1-year medical costs associated with second fracture(s) for patients over 50 years old with an initial closed hip, clinical vertebral, or nonhip nonvertebral fracture using 2002-2008 MarketScan® Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases.

How to Develop a PFC Program

human
  1. Identify a champion to develop, implement, and provide clinical leadership to the program7
  2. Secure commitment from multiple stakeholders across the care continuum7
  3. The 7 Elements Framework can be used to help model a high functioning PFC Program3
  • PFC Stakeholders3,7
  • 7 Elements of a High-Functioning PFC Program1,3,8

Various Stakeholders May Be Involved in PFC Program7

PFC-champion

PFC Champion

Specialties

Orthopedics
Geriatrics
Endocrinology
Rheumatology
Nephrology
Gynecology
Radiology

Primary Care

Family practitioners

Hospitalists

Internal medicine

coordinator-APP

Coordinator, Usually APPs (RN, PA, NP)

Additional care-team stakeholders

Discharge planners
Physical therapists
Care managers

7B4E26B7-053A-4330-A67C-FE851A7E169E

Supporting Roles

Hospital administration and management

Hospital utilization managers
Care management leadership
Finance
Research departments
Quality improvement
professionals
Pharmacists
IT department

  • PFC-champion

    PFC Champion

    Specialties

    Orthopedics

    Geriatrics

    Endocrinology

    Rheumatology

    Nephrology

    Gynecology

    Radiology

    Primary Care

    Family practitioners

    Hospitalists

    Internal medicine

  • coordinator-APP

    Coordinator, Usually APPs (RN, PA, NP)

    Additional care-team stakeholders

    Discharge planners

    Physical therapists

    Care managers

  • 7B4E26B7-053A-4330-A67C-FE851A7E169E

    Supporting Roles

    Hospital administration and management

    Hospital utilization managers

    Care management leadership

    Finance

    Research departments

    Quality improvement

    professionals

    Pharmacists

    IT department

1
2
3
  • A PFC champion can develop, implement, and provide clinical leadership to a PFC program7
  • It is important to engage with local administrators to seek funding and support7
  • Primary care providers play a key role in referring patients and in long-term management of fracture patients3,7

APP=advanced practice provider; NP=nurse practitioner; PA=physician associate; RN=registered nurse.

  • Group 492x

    Element 1:

    Identification3

    Identifying patients who may have had a fragility fracture and are in need of post-fracture disease management

  • Group 1622x

    Element 2:

    Investigation3

    Investigating patients with potential fragility fracture for future fracture risk and diagnosing patients with osteoporosis

  • Group 1632x

    Element 3:

    Intervention3

    Initiating intervention for eligible patients diagnosed with osteoporosis

  • Group 164 1

    Element 4:

    Information3

    Educating patients on osteoporosis and secondary prevention of fracture

  • Group 165

    Element 5:

    Integration3

    Coordinating communication and patient management across all stakeholders involved in care

  • Group 166

    Element 6:

    Database1,3,8

    Collecting, tracking, and analyzing PFC clinical and quality data using a database

  • Group 167

    Element 7:

    Quality1,3

    Institutionalizing PFC quality improvement as part of the organizational culture

1
2
3
4
5
6
7
Click here to learn more

PFC Stakeholders3,7

Various Stakeholders May Be Involved in a PFC Program7

  • PFC-champion

    PFC Champion

    Specialties

    Orthopedics

    Geriatrics

    Endocrinology

    Rheumatology

    Nephrology

    Gynecology

    Radiology

    Primary Care

    Family practitioners

    Hospitalists

    Internal medicine

  • coordinator-APP

    Coordinator, Usually APPs (RN, PA, NP)

    Additional care-team stakeholders

    Discharge planners

    Physical therapists

    Care managers

  • 7B4E26B7-053A-4330-A67C-FE851A7E169E

    Supporting Roles

    Hospital administration and management

    Hospital utilization managers

    Care management leadership

    Finance

    Research departments

    Quality improvement

    professionals

    Pharmacists

    IT department

1
2
3
  • A PFC champion can develop, implement, and provide clinical leadership to a PFC program7
  • It is important to engage with local administrators to seek funding and support7
  • Primary care providers play a key role in referring patients and in long-term management of fracture patients3,7

APP=advanced practice provider; NP=nurse practitioner; PA=physician associate; RN=registered nurse.

7 Elements of a High-Functioning PFC Program1,3,8

  • Group 492x

    Element 1:

    Identification3

    Identifying patients who may have had a fragility fracture and are in need of post-fracture disease management

  • Group 1622x

    Element 2:

    Investigation3

    Investigating patients with potential fragility fracture for future fracture risk and diagnosing patients with osteoporosis

  • Group 1632x

    Element 3:

    Intervention3

    Initiating intervention for eligible patients diagnosed with osteoporosis

  • Group 164 1

    Element 4:

    Information3

    Educating patients on osteoporosis and secondary prevention of fracture

  • Group 165

    Element 5:

    Integration3

    Coordinating communication and patient management across all stakeholders involved in care

  • Group 166

    Element 6:

    Database1,3,8

    Collecting, tracking, and analyzing PFC clinical and quality data using a database

  • Group 167

    Element 7:

    Quality1,3

    Institutionalizing PFC quality improvement as part of the organizational culture

1
2
3
4
5
6
7
Click here to learn more

References: 1. Curtis JC, Silverman SL. Commentary: The five Ws of a fracture liaison service: why, who, what, where and how? In osteoporosis, we reap what we sow. Curr Osteoporos Rep. 2013;11. doi:10.1007/s11914-013-0177-9. 2. Capture the Fracture. What is a post fracture care coordination program (PFC)? Accessed February 15, 2022. https:// www.capturethefracture.org/what-is-a-pfc. 3. Miller AN, Lake AF, Emory CL. Establishing a fracture liaison service: an orthopaedic approach. J Bone Joint Surg Am. 2015;97:675-681. 4. van Geel TACM, van Helden S, Geusens PP, Winkens B, Dinant G-J. Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis. 2009;68:99-102. 5. Song X, Shi N, Badamgarav E, et al. Cost burden of second fracture in the US health system. Bone. 2011;48:828-836. 6. Camacho PM, Petak S, Binkley N, et al. American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis-2020 Update. Endocr Pract. 2020;26(suppl 1):1-46. 7. National Osteoporosis Foundation website. FLS stakeholder roles. Accessed February 15, 2022. https://www.bonesource.org/fls-stakeholderroles. 8. Akesson K, Marsh D, Mitchell PJ. Capture the Fracture: a Best Practice Framework and global campaign to break the fragility fracture cycle. Osteoporos Int. 2013;24:2135-2152.

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