Fragile Fracture Care Management Program

Previous osteoporotic fracture is a strong risk factor for recurrent fracture, both in men and in women,1–7 yet only one in five patients receive osteoporosis intervention after sustaining a fracture.8 In 2003, implementation of a new HEDIS measure assessing health plan performance on postfracture care reflected national recognition of the importance and magnitude of this issue. The HEDIS measure assesses the percentage of women 67 years of age and older who receive either a bone mineral density (BMD) test or a prescription for an osteoporosis drug within six months after sustaining a fracture. Data available from the Kaiser Permanente Northern California Region (KPNC) in 1999 showed a need to improve our postfracture care. Only 6% of women and <1% of men had received bone densitometry testing after an osteoporotic fracture of the hip, spine, wrist, or humerus. Similarly low percentages were found for initiation of osteoporosis medication for women (7%) and men (2%) (BE, unpublished data, 1999). The Fragile Fracture Care Management (FFCM) Program was a year-long pilot project implemented in July 2003 at the KP Vacaville Medical Center. The goal of the project was to evaluate efficacy of a care management program in increasing the rate of BMD testing and initiation of osteoporosis medication among women and men who have had a fragility fracture of the wrist, hip, spine, or humerus.