Q Exchange
Early referral for bone health management, preventing fragility fractures & hospitalisation
- Winning idea
- 2023
Meet the team
Also:
- Adam Gregory
- Elaine Li
- Mary O'Hara
- Rosemerry Mensah
- Amy Mighalls
- Adriana Baila
- Charlotte Critchey
What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?
It is suggested that 12% of people aged 65 or over are living with moderate frailty. At present methods of identification of potential bone health issues nationally are not as timely or robust as they could be, and are more reliant on local efficiencies and initiatives. As a result, patients may go on to sustain life changing fragility fractures, which impact on quality of life, leading to lengthy hospital admissions, accelerate Frailty progression and ultimately significant cost implications for the NHS. Evidence demonstrates a programme of targeted screening will reduce the risk of fragility fractures. Prevention is certainly better than cure and the impact of preventative management of such conditions will therefor enable prioritisation of services for those that truly need them, ensuring timely access to these services and improved patient experiences.
What does your project aim to achieve?
There is increased mortality associated with fragility fractures caused by osteoporosis.
A local pilot has lead to 70 cases of timely diagnostics & bone health management over a 15 month period. We aim to:
· Increasing the identification of patients requiring bone health investigation from Community Teams to 140 patients within the next 18 months;
· Train at least 2 Community Therapy staff to a more in-depth understanding of the issues of bone health
· Develop a systematic approach to identification with the use of the FRAX tool and encourage collaboration between Community Teams & integrated care network
· Increase awareness and identification, including engagement and education sessions with Integrated Care System linking in with Primary care.
· Tackling falls and fractures requires a whole system multi –agency approach, including a focus on ‘at-risk’ populations. At Croydon we aim to strengthen effective joint working between community therapists, falls and fracture services as a step towards an end-to-end pathway for addressing Bone Health
How will the project be delivered?
Early screening/referral directed to Falls and Bone Health or via Rheumatology is inconsistent currently. Data for these cases currently referred/ gathered demonstrate proof of concept. The term aim will contribute to a reduction in the number of fragility fractures for patients, ultimately, reducing delays in treatment and hospital inpatient services.
Specific action in the delivery of the project will include:
· Upskilling/ training with Therapy staff in the use of FRAX assessment tool for use with all patients:
· Targeting people aged 50+yrs who have had a fragility fracture for screening
· Systemise use of FRAX for patients who are a Clinical Frailty Score (CFS) of 5+ at the point of assessment in our service
Increase team resource to support demand/capacity in the teams, balancing growth/impact as earlier intervention measures become embedded
How is your project going to share learning?
All activity will be shared through the relevant Q Community specialist interest groups
We will submit a poster presentation to the South West London QI Conference to share learning across the region
How you can contribute
- Learning from similar "prevention is better than cure" approaches in other areas
- Best practice from ‘critical friends’ ~ professionals with experience
Plan timeline
| 1 Jun 2023 | planning: project team, key stakeholders, schedule of meetings, baseline data |
|---|---|
| 1 Sep 2023 | delivery: systems & processes, people, information & communication plans |
| 1 Apr 2024 | evaluation& sustainability: data & analytics |
Project updates
23 Jun 2023
Congratulations to the Team, especially Adam – such an important early intervention and preventative project.
Looking forward to moving the project into the mainstream functionality of the Bone Health Service.
Comments
Ritu Karlekar 6 Jun 2023
Dear Adam and Croydon QI team,
Wishing the team the very best in the future work to address the under-represented issue of bone health in the community. In a resource limited environment, preventing every possible fracture is a win-win situation for the patient and the health system.
Liz Geary 5 Jun 2023
Looking forward to working with Adam and the wider team to develop links between the FLS and the ICN+ Networks to identify pt / residents of Croydon who are at risk of frality to improve health outcomes.
Emma Sutton 31 May 2023
Dear Sam and Chris, I am just wondering if it would be good for us to connect as we are two teams both interested in promoting health and good care pathways for patients with fragility fracture? We are looking at different aspects of the patient journey, but share the same passion. I also sit on an international research group with the fragility fracture network and there are lots of opportunities there for sharing both research and QI, so there could be opportunity for collaborative dissemination with shared presentations etc. If you feel able please also give our idea a 'like' and do keep in touch, Emma and team.
Adam Gregory 31 May 2023
Thank you so much Emma for your supportive comments here, I have added comment on your great project, as awaiting membership I am afraid I cannot add vote, but perhaps my colleagues will, or I will if/when able. It would be a excellent opportunity to explain more of our journey so far to you at some stage given your position within the fragility fracture world. We have further ideas ongoing within our FLS also for which this project will support to to move towards hopefully. I am essentially trying to enhance the ability of our community teams and integrated care system to identify these patients better, and establish pathways for appropriate referral into our FLS, and also proactive links in with primary care where patients identified can be be managed via this route. It is quite ambitious, but signs something very meaningful can be achieved!
Adam Gregory 30 May 2023
Further to the theme of FRAX from previous message, just to update on progress with this project since the end of pilot phase in January 2023 (which had run over 15 months with the identification of 70 patients from community- mainly by 1 individual). There have been 175 patients identified in the last 5 months for bone health intervention which is a positive increase, wider use of FRAX has been part of this across community teams and colleagues, in some cases newly introduced to their practice. The hope is to continue to expand this as the clear potential has indicated to us is possible.
Rachel McLean 30 May 2023
This is a great project. We (centre for sustainable healthcare) recently worked with a team considering how use of the FRAX tool and fracture prevention is more sustainable from a clinical, social, financial and environmental perspective - it would be great to see environmental sustainability mentioned (this would link to sustainable models of care and clinical engagement within your organisations Green Plan).
Here is a link to the teams report.
Rachel
Adam gregory 2 Jun 2023
Hi Rachel, as previously thanks again. Please consider sharing with those you feel our project will resonate with and who will support our valuable innovation
Adam Gregory 30 May 2023
Thank you very much for your support Rachel, and also for sharing this link to your interesting project which has very similar aims. Although similar aims this looks at it from a different perspective which was interesting to read about, perhaps it would be good to talk further at a later date!
Adam gregory 26 May 2023
Thanks all for wonderfully supportive comments, likes and votes so far. Please spread word regarding this valuable collaborative preventative project. Happy to be contacted whenever for more info, Adam Gregory
Christine Quinn 28 Mar 2023
An excellent project to try and improve bone health/education to prevent unecessary fractures. The inclusion of a dietitician/nutritionist in the team would be an advantage.
Dawn Eustace 28 Mar 2023
This excellent project is focussing on reducing the length of time people with potential bone health conditions wait for treatment or support. Early interaction and assessment using the FRAX tool (as recommended by ROS) can speed up the referral process. The team have data to support referrals are made with accurate information, potentially leading to early diagnostics and an opportunity for the teams at Croydon to provide an holistic approach to maintaining or improving potential or actual bone health conditions. Without the use of the FRAX tool patients/potential patients could be waiting considerably longer to access healthcare services and may not be picked up as a 'high risk' until a fall has resulted in a fracture and inpatient services accessed.
A cost analysis provided by the ROS suggests that there could potentially be savings of £150,000 over a 5 year period, based on 100 people already identified via FRAX.
As with preventative measures the actual benefit is to the patient, with bone health conditions being identified early, and an opportunity of holistic approaches, collaborated between community services and acute services. The pressure on inpatient services is reduced, the quality of care for patients maintained or improved (Falls and Bone Health Services providing an 'end to end' approach) and the waiting lists less challenged, as 'high risk' individuals are directed correctly and more speedily to the appropriate healthcare services.
Excellent example of innovation and a multi agency approach.
Elaine Li 28 Mar 2023
Over the years, the Falls/Bone Health Practitioners have worked hard to develop the Fracture Liaison Service (FLS) and are very keen to collaborate with other services so that patients can be early identified and falls/fragility fractures can be prevented in line with the frailty work. The work that Adam has been doing is fantastic. This project is a great opportunity to do this, and with the correct funding and support, a pathway for patient's osteoporosis/bone health experience could be mapped out, from community to the FLS back out into the community, and implemented. This will benefit our older residents in Croydon to improve health and quality of life and, raise standards in the NHS.
Adam gregory 3 Jun 2023
Thanks again Elaine, very encouraging now we have made early progress with pathways development planning. There has been good community engagement from a range of teams and now ICS, the innovation continues!
Ritu Karlekar 27 Mar 2023
I share the passion for providing appropriate identification and treatment to those patients, 50 and above who have suffered a fragility fracture. If the knowledge about using FRAX score is applied correctly, it can help highlight those at high risk of fragility fractures. It is encouraging to see bne health education introduced as part of PD educational classes as a rsult of the work done by Adam and there is great work being done by the falls and bone health team in Croydon. Securing funding to improve the reach of bone health education amongst staff and patients alike as well as support adequate staffing to sustain timely bone health intervention by the FLS is vital to raise the standards of bone health intervention in Croydon even further. I wish the team the very best is their endeavour.
Ruth Pyke 27 Mar 2023
This is a forward thinking innovation with patients at the forefront, with the added benefit of savings for the NHS.
It seems like a win win for a very modest cost with far reaching benefits for patients and allied services.
Very much needed!
Dawn Eustace 23 Jun 2023
Thank you so much for your support - we were lucky to be chosen as one of the winners
Sarah McKenzie 27 Mar 2023
A fantastic project which will benefit patients and help improve their quality of life.
Great to see such a positive initiative for the wonderful Croydon community!
Dawn Eustace 23 Jun 2023
Thank you for you so much for your support - We were one of the winners!
Steve Shevel 27 Mar 2023
This project sounds really useful and should provide health and quality of life benefits to the people of Croydon.
Dawn Eustace 23 Jun 2023
Thank you for your support - we were lucky to be one of the winners.
Viji Unnithan 27 Mar 2023
It is really a brilliant initiative. This project is very much beneficial to Croydon residents especially to the elderly population. Fractures from falls and thus having a great impact on their quality of life. I hope this project will help to identify those at risk and will be able to take appropriate action to diagnose and treat them at an early stage.
Dawn Eustace 23 Jun 2023
Thank you for your support - we were one of the winners!
Beena Ali 27 Mar 2023
This project would be really useful for the community. Hope the funding is agreed to support this. All the best
Dawn Eustace 23 Jun 2023
Thank you for your support - We were one of the winners!
Lisa Connolly 27 Mar 2023
This sounds like a great initiative to support population health management.
Dawn Eustace 23 Jun 2023
Thank you for your support- we were one of the winners!
Nike Okoh 26 Mar 2023
We have all have been working and will continue to work towards reducing the risk of falls however reality is that there are multifactorial cause of falls and the potential consequences . I believe this project will be of benefit to a significant number of a risk population of Croydon ( e.g Elderly , Frail, Patients with a neurological diagnosis such as Parkinson’s , Multiple Sclerosis ,Stroke, Epilepsy )and those at risk of fragility fractures .
With Adam's experience and passion in raising awareness of bone health in the domiciliary Physiotherapy Service, we have been able to identify some Patients that require bone health management however we are a service with various demands , priorities ,limited capacity and resources , hence I hope this project can be provided with funding/ resources required
With Regards,
Nike Okoh
Dawn Eustace 23 Jun 2023
Thank you for your support - we were winners!
Karen Brown 23 Mar 2023
Hi all,
A really great idea with an even better team behind it- would be great to see this receive the funding it needs to progress. It aligns with the work we are doing around proactive and preventative care within the ICN+ model, and Frailty is a key priority area within this- as well as in South West London's Anticipatory Care Workstream. It also supports the aim to make Frailty everyone's responsibility, and train and upskill staff to identify signs earlier to allow people to access support before reaching a crisis point such as having a fall/fracture.
More than happy to support in anyway we can through the ICN+ programme.
Thanks,
Karen
Dawn Eustace 23 Jun 2023
Thank you Karen, we were one of the winners!
Sabrina Vandendris 23 Mar 2023
Hi All,
This is a great piece of work and so very needed in Croydon. I am happy to support with identification and with process mapping if at all helpful.
Best of luck
Dawn Eustace 23 Jun 2023
Thank you Sabrina, we were one of the winners!
Amy Mighalls 23 Mar 2023
Dear all,
I think this project is extremely important for the people of Croydon. We have huge health inequality and a diverse population that we need to be looking into ways we can prevent the need for hospitalisation and reduce long term health costs and this is one way. This project is one that stretches further than older people medicine as there has already been patients identified with a neurological diagnosis such as Parkinson’s and those who are at risk of falls such as those with MS and stroke. There can be some great collaboration between services and specialities. Through Adams education to staff already, we have incorporated bone health education into our Parkinson's education group.
I really hope that this project is supported.
Amy
Dawn Eustace 23 Jun 2023
Thank you for your support - we were one of the winners!
Adam gregory 3 Jun 2023
Thank you again Amy. The addition of a bone health educational component with the PD group is such a valuable public health development and hopefully a good example for other teams and services. Thank you for implementing this.
Cerys Gittins 23 Mar 2023
Sounds like a great project!
Mary O'Hara 22 Mar 2023
Dear Jill and all
I am so pleased that this initiative has been highlighted by the Royal Osteoporosis Society. It will indeed enable many people in our Borough to have interventions that will help them live well and be truly supported.
Let us hope that we will be able to move forward positively
Best wishes
Mary
Operational Clinical Lead
Adam Gregory 22 Mar 2023
Thank you very much Jill for your support. I am extremely passionate about this project, and the wider benefits this can have for Croydon residents for both quality of life and reduction of admission risk and length of admission. I also feel it is the sort of innovation and forward thinking approach to longer term conditions such as Osteoporosis that is required. My passion is to try to reach as many patients who have to date 'slipped through' the system, but go on to be increasingly at risk of life changing fragility fractures, in order for us to intervene and provide suitable treatment and support for them at the earliest opportunity. I am enjoying the challenge of engaging as many individuals and teams as possible within Croydon Community services who can support this mission.
Jill GRIFFIN 21 Mar 2023
This is a great innovation, and something the Royal Osteoporosis Society are exploring in its policy work this year. Do get in touch we may have some data we can share with you or support.
Dawn Eustace 23 Jun 2023
Dear Jill,
Thank you for your support. We are so pleased to be chosen as one of the winners! Now its time for us to fully implement and make a real difference.
Adam gregory 3 Jun 2023
Thanks again Jill. Would be great to be back in touch about this and whether the work we have undertaken could assist you and vice versa. We have been identifying some very important cases that have slipped through, it is rewarding to know we are able to help them reduce future fracture risk
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