A quality improvement initiative on the management of osteoporosis in older people with Parkinsonism

Singh, Inderpal; Fletcher, Rachel; Scanlon, Linda; Tyler, Mandy; Aithal, S

doi:10.1136/bmjquality.u210921.w5756

Cited by 8 publications

(9 citation statements)

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“…Integrated PD services with an existing osteoporosis or bone health clinic could help those with severe osteoporosis. We propose quality improvement initiatives, based on the model of improvement (Plan-Do-Study-Act Cycle) to review existing PD services to ensure that all PwP are treated for osteoporosis [31]. We also recommend similar studies to measure the prevalence of osteoporosis in PD in other centres, as we expect that osteoporosis is under reported.…”

Section: Discussionmentioning

confidence: 99%

Fragility Fractures and Parkinsonism: Relationship of Fractures with Demography, Severity and Predictors of Adverse Outcomes

2017

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Background:The risk of falls is higher in patients with Parkinsonism (PwP) as compared to other older adults, leading to adverse outcomes including fragility fractures. Osteoporosis is under-recognised and the current prevalence of fragility fractures is not well-studied. The objectives of this study are to determine the prevalence of fragility fractures in PwP, to measure the relationship of fractures with demography, severity and to measure predictors of adverse outcomes in this population. Method/Description: This was a retrospective observational cohort study based on the analysis of existing data for all the patients attending Caerphilly Movement Disorder Clinic. Information on demographics, the severity of Parkinsonism and fragility fractures was extracted electronically from the clinical workstation, clinic letters and coding from January 2015 to October 2016. Results: 397 people (mean age = 77.1 ± 9.4, 46% females) were studied. Of these, 77% (306/397) had Parkinsonism and 80% (244/306) had idiopathic Parkinson's disease (PD). The mean Hoehn & Yahr Score at the time assessment was 3.09 ± 1.16. Additionally, 23.5% (72/306) were deemed to have osteoporosis based on the radiological evidence of fragility fractures. The PwP who sustained fractures were comparatively older (80.4 ± 12.1) and 70% (50/72) were females. The most common site for fractures was vertebral (47.2%; 34/72). Also, 22.2% of the sample (16/72) had suffered a fragility fracture before the diagnosis of PD. However, a majority (77.8%; 56/72) had sustained a fracture during the course of PD with a mean lapse of 6 years (range = 0-13 years) from initial diagnosis. Only 40% (29/72) of patients were prescribed osteoporosis drugs as per guidelines. There is a significant correlation of advancing age, severity and duration of PD with fragility fractures. The single best predictor of mortality is severity of PD, followed by age and fractures. Conclusions: There is a high prevalence of fragility fractures in patients attending movement disorder clinics, although 60% do not receive evidence-based medical treatment for the underlying osteoporosis. The prevalence of fragility fractures is positively correlated with the duration and severity of PD. We acknowledge the relatively small sample size as the study's limitation.

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Section: Discussionmentioning

confidence: 99%

Fragility Fractures and Parkinsonism: Relationship of Fractures with Demography, Severity and Predictors of Adverse Outcomes

2017

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“…Quality initiatives based on the PDSA model of improvement have been employed and implemented in various services and have shown significant improvement in patient-related clinical outcomes. 81 – 85 A higher inpatient falls rate was observed in a hospital with 100% single rooms with en-suite facilities. A geriatrician-led, systematic nurse-training program on the understanding and correct use of an existing multifactorial falls risk assessment tool was developed using a PDSA methodology.…”

Section: Applying Qi Methodology To Improve Patient Carementioning

confidence: 99%

“…QI work was undertaken by two consultant geriatricians, and case-based discussion (CBD) to assess falls and bone health for each patient with Parkinsonism with osteoporosis on a weekly basis was introduced. 85 Lessons were learnt and CBD was later developed into a monthly multidisciplinary meeting using PDSA methodology to include a physiotherapist and a Parkinson’s Disease Nurse Specialist. The results showed that following the introduction of quality initiatives, 91% of PwP were treated according to guidance: a 56% increase.…”

Section: Applying Qi Methodology To Improve Patient Carementioning

confidence: 99%

“…The results showed that following the introduction of quality initiatives, 91% of PwP were treated according to guidance: a 56% increase. 85 The improvement work was also spread to the community to ensure that all patients receive evidence-based treatment on an all-inclusive approach to reduce inappropriate variation and promoting partnership working with GP. 86 All patients who were deemed to be on inappropriate drugs, untreated, or at treatment failure were discussed in the consultant-led CBD with the general practitioner and practice staff virtually.…”

Section: Applying Qi Methodology To Improve Patient Carementioning

confidence: 99%

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Selecting best-suited “patient-related outcomes” in older people admitted to an acute geriatric or emergency frailty unit and applying quality improvement research to improve patient care

Singh¹,

Aithal²

2018

PROM

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The population is aging worldwide, and hospitals are admitting a higher proportion of acutely unwell older people. Population-specific factors such as multimorbidity and frailty in older people compounded by deficient expertise contribute to longer lengths of stay, higher readmission rates, and increased rates of institutionalization. A wide range of acute geriatric care models are currently providing acute care to frail older people and these have been shown to provide a cost-effective high-quality service. In this review, population-specific factors, service models, and a wide range of patient-related outcomes of “at risk” older people admitted to an acute geriatric care unit are explored. In addition, we also discuss data measurements and a quality improvement methodology to improve the delivery of care based on the patient outcome data. We hope, in addition to ensuring effectiveness and sustainability of our current services, this may also enhance academic research. Regular monitoring and evaluation of patient-related clinical outcomes not only improve the patient care and reduce the caregiver burden but also help in implementing quality initiatives to develop existing services.

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“…10 A quality improvement (QI) methodology based on the model of improvement, Plan-Do-Study-Act (PDSA) cycles in people with parkinsonism showed a 56% increase in treating underlying osteoporosis according to guidance. 11 The primary aim of this feasibility study was to measure the prevalence of fragility fractures in all patients above 50 years of age according to Quality and Outcomes Framework (QOF) of the General Medical Services (GMS) contract 12 in a relatively low socio-economic status and well defined geographic population in Caerphilly County Borough, Wales, UK. Our secondary aim was to complete descriptive analysis of the population and study the co-morbidity burden and bridge the gaps in the evidence-based osteoporosis treatment in the General Practice by applying quality improvement methodology to improve patient care.…”

Section: Introductionmentioning

confidence: 99%

Untitled

2018

MOJGG

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Introduction: Osteoporosis is defined as a reduction in bone mineral density resulting in reduced bone strength and increase the risk of fractures. Osteoporosis is a silent condition and often diagnosed following a fracture which has a huge impact on person's life. The aim of this feasibility study was to measure the prevalence of fragility fractures in all patients above 50 years of age according to Quality and Outcomes Framework (QOF) of the General Medical Services (GMS) contract and apply quality improvement methodology to improve osteoporosis care. Method: This was a retrospective observational study to complete analysis for all known patients above age 50 years with diagnosed osteoporosis, known fragility fracture or prescribed osteoporosis treatment according to a General Practice database. General Practice staff was actively involved to implement quality initiatives. The pilot study was classed as service evaluation project according to health research authority decision tool. Results: The practice has 6300 patients on 1st Oct 2017 and 320 were included but 6 patients were excluded. Analysis was completed for 314 patients. The mean age of studied cohort (above 50 years age) was 75.5±10.5 years and 66.9% (210/314) were female. Mean number of co-morbidities for the studied population was 4.4±2.8. 66% (208/314) patients were on polypharmacy and the mean number of drugs was 6.8±4.2. 45.5% (143/314) had recorded fracture and of that 83 % (116/140) were classed as a fragility fracture (vertebra, wrist, hip, humorous and pelvis). 89 patients were on osteoporosis drugs, 44% (51/116) patients diagnosed fragility fractures were on appropriate treatment. 33.4% (40/116) patients were not treated according to guidance and 7.3% (23/314) were prescribed osteoporosis drugs inappropriately. 43.6% (137/314) patients were discussed as part of quality initiatives and were treated to guidance. Conclusion: This study suggests that an average practice of 6000 patients could have 2% prevalence of fragility fractures and one-third may not be treated to guidance. Regular monitoring of practice data and implementing quality initiatives enhance autonomous osteoporosis care by general practice doctors. Similar intervention is needed more widely to prevent a second fracture.

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A quality improvement initiative on the management of osteoporosis in older people with Parkinsonism

Cited by 8 publications

References 20 publications

Fragility Fractures and Parkinsonism: Relationship of Fractures with Demography, Severity and Predictors of Adverse Outcomes

Fragility Fractures and Parkinsonism: Relationship of Fractures with Demography, Severity and Predictors of Adverse Outcomes

Selecting best-suited “patient-related outcomes” in older people admitted to an acute geriatric or emergency frailty unit and applying quality improvement research to improve patient care

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A quality improvement initiative on the management of osteoporosis in older people with Parkinsonism

Cited by 8 publications

References 20 publications

Fragility Fractures and Parkinsonism: Relationship of Fractures with Demography, Severity and Predictors of Adverse Outcomes

Fragility Fractures and Parkinsonism: Relationship of Fractures with Demography, Severity and Predictors of Adverse Outcomes

Selecting best-suited &ldquo;patient-related outcomes&rdquo; in older people admitted to an acute geriatric or emergency frailty unit and applying quality improvement research to improve patient care

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Selecting best-suited “patient-related outcomes” in older people admitted to an acute geriatric or emergency frailty unit and applying quality improvement research to improve patient care