Patient performance indicators to measure effectiveness of fracture liaison services

Nearly a dozen patient-level key performance indicators (KPIs) for fracture liaison services (FLSs) to guide quality improvement have been selected by the International Osteoporosis Foundation (IOF) Capture the Fracture campaign, in collaboration with the Fragility Fracture Network (FFN) and National Osteoporosis Foundation (NOF).

Ten of the 11 KPIs were for the following parameters (all measured in terms of percentage of patients with them):

• Non-spinal fractures

• Spine fractures (detected clinically and radiologically);

• Evaluation for fracture risk within 12 weeks of sentinel fracture

• Dual-energy X-ray absorptiometry (DXA) assessment within 12 weeks of sentinel fracture

• Falls risk assessment

• Recommended anti-osteoporosis medication

• Beginning strength and balance exercise intervention within 16 weeks of sentinel fracture

• Monitoring within 16 weeks of sentinel fracture

• Starting anti-osteoporosis medication within 16 weeks of sentinel fracture

• Prescription of anti-osteoporosis medication 52 weeks after sentinel fracture.

The remaining KPI outlined in Osteoporosis International is data completeness for each of the aforementioned KPIs.

“These performance indicators were developed in response to working with FLS mentors globally and realizing we need a common framework for assessing FLS,” said senior author Kassim Javaid, MD, PhD, an associate professor of adult metabolic bone disease at the University of Oxford in the United Kingdom, who led the team. Existing metrics from the UK-based Fracture Liaison Service Database Audit were adapted for the KPI set.

“Not every FLS is automatically effective,” Dr. Javaid told Contemporary OB/GYN. “Previously, the IOF Capture the Fracture working group developed and implemented the Best Practice Framework to assess the organizational components of an FLS. This complimentary KPI set extends that assessment of performance to the patient level.”

Evidence of the benefits of secondary fracture prevention is leading to the prioritization of FLS implementation by decision-makers around the world, according to Dr. Javaid. The indicators underscore the need for FLSs to include follow-up as part of their routine care pathway and a required upskilling in quality improvement.

“The 11 indicators were developed to support FLSs to review their current performance, prioritize areas for improvement, implement changes and then analyze the impact,” Dr. Javaid said. “Each indicator has an expected level of achievement that will be revised as services improve.”

Achievement performance has been set at three levels: less than 50%, 50% to 80%, and greater than 80%, except for treatment recommendations with a performance level of 50%. The indicator set will allow FLSs to benchmark their performance regionally, nationally, and internationally.

“Continuous quality improvement using this indicator set will enable FLSs-whatever their service model or local healthcare setting-to maximize effectiveness, efficiency and patient experience, thus deliver benefits for families, carers and the wider healthcare system,” Dr. Javaid said.

The performance indicators also enable FLSs to better understand how well their FLS is currently working, what areas need improving and the ability to measure the impact of changing FLS delivery. “By using this KPI set for local quality improvement cycles, FLSs will be able to efficiently realize the full potential of secondary fracture prevention and improve clinical outcomes for their local populations,” Dr. Javaid said. “It would also be helpful if a community of FLSs published their performance and experiences in quality improvement using our KPIs.”

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Dr. Javaid reports no relevant financial disclosures.