Another question we recently received with regard to geriatric services is: What about building an osteoporosis screening and/or fall prevention clinic?
As hospitals turn to preventive and screening services to improve utilization management and increase upstream market share, screening for osteoporosis and efforts to prevent falls offer an option for reducing fracture rates among frail, elderly patients. Estimates suggest that half of women are at risk of osteoporosis-related fractures during their lifetime.
The U.S. Preventive Services Task Force (USPSTF) issued guidelines earlier this year that gave a “B” recommendation to osteoporosis screening for women ages 65 or older and younger women with fracture risk factors. Though the report concludes that “No controlled studies have evaluated the effect of screening for osteoporosis on fracture rates or fracture-related morbidity or mortality,” it still finds enough evidence to conclude that drug therapies reduce the risk of fractures and that “the benefit of screening-detected osteoporosis is at least moderate” for women. The USPSTF did not find enough evidence to recommend osteoporosis screening in men, who are at lower rates of osteoporosis-related fractures. Similarly, in a draft statement, USPSTF gave a “B” recommendation to some falls prevention efforts.
Only a few examples of osteoporosis screening and fall prevention programs are available. Most, like UNT Health Services, have simple websites advertising the services. Often, rheumatologists and orthopedists are involved in the programs. Others involved in the program may include the patient’s primary care physician, dieticians, physical therapists, pharmacists, occupational therapists, and social workers. In addition to screening, programs offer education on fall prevention, nutrition, and coping with pain.
Some institutions have begun using the American Orthopedic Association’s Own the Bone program as a way to prevent fractures in osteoporotic patients, but the program is focused on secondary rather than primary prevention. According to a recent study, fracture patients whose orthopedist participates in the program are more likely to be screened for osteoporosis and receive preventive therapy.
Hospitals could benefit from osteoporosis screening programs through several channels: First, by identifying those most at-risk of fractures, hospitals would be able to maximize efforts to prevent fractures and potentially reduce utilization. For organizations participating in shared savings-style programs, such a program could be part of a larger utilization reduction strategy. Such clinics might also serve as a useful way to engage patients in the health system's offerings and increase market share further upstream. Patients who still experience fractures, despite best efforts at prevention, might be more likely to receive care within the system rather than at a competing hospital.
For those with experience offering an osteoporosis screening program, we would love to hear your thoughts on the critical pieces and/or benefits of such a program in the comment section below.
In addition to the links above, we recently summarized several hospital-based geriatric fracture programs on our blog. In addition, the Marketing and Planning Leadership Council recently hosted a webconference on "Geriatric Services Strategy." Finally, the Council’s newest study Orthopedics: Service Line Strategic Outlook, provides a good summary of orthopedic-related trends.