Fracture liaison service model: project design and accreditation

Abstract

Frailty fractures place a significant socioeconomic burden on the health care system. The Italian Society of Orthopaedics and Traumatology (SIOT) is proceeding to fracture liaison service (FLS) model accreditation in several Italian Fracture Units (FUs), which provides a multidisciplinary approach for the management of the fragility fracture patient. Introduction Osteoporosis and the resulting fragility fractures, particularly femoral fractures, place significant socioeconomic burdens on the health care system globally. In addition, there is a general lack of awareness of osteoporosis, resulting in underestimation of the associated risks and suboptimal treatment of the disease. The fracture liaison service (FLS) represents an exemplary model of post-fracture care that involves a multidisciplinary approach to the frail patient through the collaboration of multiple specialists. The purpose of this article is to highlight the path undertaken by the Italian Society of Orthopaedics and Traumatology (SIOT) for the purpose of certification of numerous FLS centers throughout Italy. Methods SIOT is proceeding with international FLS accreditation in several Italian Fracture Units (FUs), following the creation of a model that provides specific operational and procedural steps for the management of fragility fractures throughout the country. FUs that decide to join the project and implement this model within their facility are then audited by an ACCREDIA-accredited medical certification body. ResultsThe drafted FLS model, thanks to the active involvement of a panel of experts appointed by SIOT, outlines a reference operational model that describes a fluid and articulated process that identifies the procedure of identification, description of diagnostic framing, and subsequent initiation of appropriate secondary prevention programs for fractures of individuals who have presented with a recent fragility fracture of the femur. Conclusion Accreditation of this prevention model will enable many facilities to take advantage of this dedicated diagnostictherapeutic pathway for the purpose of fracture prevention and reduction of associated health and social costs.

Effect of a Multicomponent Intervention with Tele-Rehabilitation and the Vivifrail© Exercise Programme on Functional Capacity after Hip Fracture: Study Protocol for the ActiveFLS Randomized Controlled Trial

“…We will aim to examine whether this intervention could improve functional status after hip fracture. Our ActiveFLS intervention will be developed based on high-quality evidence of FLS follow-up [ 56 , 57 ] and international guidelines [ 11 , 27 ] on hip fracture management, and it is feasible for most types of patients with little support. The use of integrated models of care based on comprehensive geriatric assessment can help align clinical practice with the individual needs of patients and enhance their quality of life [ 58 ].…”

Dementia and Hip Fractures

“…FLS encompasses a multidisciplinary team primarily focused on the treatment of osteoporosis but includes fall prevention strategies and education of patients and their families 74 . Members of this multidisciplinary team can include, but are not limited to, orthopaedic surgeons, geriatricians, physiatrists, endocrinologists, and orthopaedic nurses 75 (Fig. 3).…”

Three-year follow-up of a novel orthopedic ward fracture liaison services (OWFLS) model

“…14,17,18 FLS is a multidisciplinary functional coordination model that allows patients with fracture to quickly initiate secondary prevention plans for fractures. 16,19 In FLS, various medical professionals (orthopedic physicians, endocrinologists, geriatric physicians, radiologists, pain specialists) or specific caregivers work in collaboration. 20 Treatment adherence is increased by 20%, the treatment gap is reduced by 20%, and re-fracture and mortality rates decline by 5% when FLS is fully implemented.…”