Fracture Liaison Service Database Comparison of (Your site name) results against the national results for the Fracture Liaison Service Database

Projected volume and savings using NOS FLS calculator Measure Locality estimate Annual Projected Fragility case load Annual Actual fragility case load 5 years number of prevented All fractures 5 years number of prevented hip fractures 5 years acute healthcare saving 5 years combined social, community and healthcare saving Current annual FLS cost Optimal annual FLS cost

Participation 38 FLSs participated in this audit and submitted data on 18,356 patients.

Audit design Section 1 - Patient identification Section 2 - Investigation of bone health Section 3 - DXA Section 4 - Treatment initiation Section 5 - Falls risk assessment and outcome Section 6 - Follow-up 12-16 weeks post index fracture

Target patient population All patients they saw aged 50 or over who had sustained a fragility fracture which was diagnosed in the NHS between 1 January and 30 June 2016 NICE TA161 2.6 definition states ‘Fragility fracture: fracture occurring as the result of a force equivalent to the force of a fall from a height equal to, or less than, the height of an ordinary chair.’

Data quality National Your site Number of cases submitted 18356 >> Number of fields with >20% missing data 8.3 (average) >> out of 29 Number of fields with >50% missing data 4 (average)

Identification FLSs should compare the number of submitted fracture cases and their expected number in time for the next audit report. Percentage of estimated fragility fracture patients submitted National results Your site Hip 35.4% >> Non-Hip 45.5% Spine TBA

Diagnosis to FLS assessment (days) Identification FLSs that are not able to assess at least 80% of their patients within 90 days should consider reviewing their patient pathways and liaise with FLSs of a similar estimated fragility fracture caseload to develop local quality improvement project plans. Diagnosis to FLS assessment (days) National Results Your site Within 30 days 46.8% >> Within 90 days 66.9%

Investigation FLSs that are not able to provide DXA assessment within 90 days of the fragility fracture diagnosis for at least 80% of their patients should review their current patient pathways and discuss options with their DXA provider FLSs that are under-resourced for DXA assessment should work with their local commissioners to develop a business case for improved services Time to DXA from fracture diagnosis (days) National results Your site Within 90 days 46.5% >>

Intervention FLSs with higher than average recorded inappropriate should review their clinical pathway and liaise with other FLSs with similar case loads to understand if quality improvement is required. FLSs with higher missing therapy decisions should review their data entry methods to the audit. Bone therapy recommended: National results Your site Inappropriate 25.6% >> Missing 33.2% Don’t know 6.3%

Falls assessments and interventions FLSs not routinely performing or referring for falls risk assessment should review their current clinical pathway. FLSs with high missing data proportion rates should review their data entry process. Falls risk assessment National results Your site Performed/done/referred by the FLS 32.3% Missing 28.5%

Monitoring Patients who are recommended drug therapy to reduce risk of fracture should be reviewed within four months of initiation to ensure appropriate treatment has been started. Patients followed-up (of those prescribed bone therapy or referred for further clinical opinion or to GP) National results Your site Yes 36.4% >> Proportion of patients starting bone therapy within 4 months of fracture National results Your site Yes 22% >>

Our sites priority areas for Quality improvement Component of Secondary Fracture prevention identified for quality improvement project Project lead Implementation date Cost neutral 1. 2. Require additional funding Next upload deadline end of June 2017.

Projected volume and savings using NOS FLS calculator Measure Locality estimate Annual Projected Fragility case load Annual Actual fragility case load 5 years number of prevented All fractures 5 years number of prevented hip fractures 5 years acute healthcare saving 5 years combined social, community and healthcare saving Current annual FLS cost Optimal annual FLS cost