Global epidemiology of hip fractures: a study protocol using a common analytical platform among multiple countries

INTRODUCTION: Hip fractures are associated with a high burden of morbidity and mortality. Globally, there is wide variation in the incidence of hip fracture in people aged 50 years and older. Longitudinal and cross-geographical comparisons of health data can provide insights on aetiology, risk factors, and healthcare practices. However, systematic reviews of studies that use different methods and study periods do not permit direct comparison across geographical regions. Thus, the objective of this study is to investigate global secular trends in hip fracture incidence, mortality and use of postfracture pharmacological treatment across Asia, Oceania, North and South America, and Western and Northern Europe using a unified methodology applied to health records. METHODS AND ANALYSIS: This retrospective cohort study will use a common protocol and an analytical common data model approach to examine incidence of hip fracture across population-based databases in different geographical regions and healthcare settings. The study period will be from 2005 to 2018 subject to data availability in study sites. Patients aged 50 years and older and hospitalised due to hip fracture during the study period will be included. The primary outcome will be expressed as the annual incidence of hip fracture. Secondary outcomes will be the pharmacological treatment rate and mortality within 12 months following initial hip fracture by year. For the primary outcome, crude and standardised incidence of hip fracture will be reported. Linear regression will be used to test for time trends in the annual incidence. For secondary outcomes, the crude mortality and standardised mortality incidence will be reported. ETHICS AND DISSEMINATION: Each participating site will follow the relevant local ethics and regulatory frameworks for study approval. The results of the study will be submitted for peer-reviewed scientific publications and presented at scientific conferences

Extraction and Analysis of Data for Fragility Fracture Patients to Help Determine the Likelihood of Follow-Up With a West Michigan Fragility Fracture Service

Fragility fractures and secondary fractures are a large physical, financial, and emotional drain on the individuals and families affected. Improving post fragility fracture care and increasing follow-up rates with specialty services, such as a fracture liaison service, may promote post-fracture recovery and help prevent future fractures. The purpose of this doctoral project was to increase and improve post osteoporotic fracture care by increasing appropriate referrals and follow-up care. Patient data was retrieved and analyzed on 60 fragility fracture patients referred to a local fracture liaison service. The analysis found that patient gender, fracture site, and history of a previous fracture all played a significant role as to whether the patient would follow-up with a fracture liaison service. The Health Belief Model and the Donabedian model were used to help drive this project and provide structure to the next steps in the project. To make the results relevant to primary care providers, local outcome data was used to provider a presentation to the group. The primary care providers then completed a survey answering questions based on their impression of the patient data presentation. The provider survey response data was then analyzed for trends. Most notably, the vast majority of providers agreed that after the presentation, they had a greater understanding of the patients that were most likely to receive inadequate fragility fracture care or refuse follow-up with a fracture liaison service. This implies that the providers now have a raised awareness about these patients and fewer patients will fall through the cracks when it comes to fragility fracture care and fracture liaison service follow-up. This project format could be applied to other populations to assist in revealing each unique population’s characteristics that impact fragility fracture care and fracture liaison service follow-up. Those results could then be presented to local primary care providers to raise awareness and improve their local outcomes

Curator – a data curation tool for clinical real-world evidence

Objective This research aims to establish an efficient, systematic, reproducible, and transparent solution for advanced curation of real-world data, which are highly complex and represent an invaluable source of information for academia and industry. Materials and methods We propose a novel software solution that splits the statistical analytical pipeline into two phases. The first phase is implemented through Curator, which performs data engineering and data modelling on deidentified real-world data to achieve advanced curation and provides selected information ready to be analyzed in the second phase by statistical packages. Curator is made of a suite of Python programs and uses MySQL as its database management system. Curator has been utilised with several UK primary and secondary care data sources. Results Curator has been used in 25 completed clinical and health economics research studies. Their output has been published in 2 NIHR-funded reports and 33 prestigious international peer-reviewed journals and presented at 38 global conferences. Curator has consistently reduced research time and costs by over 36% and made research more reproducible and transparent. Discussion Curator fits in well with recent UK governmental guidelines that recognise health data curation as a complex standalone technical challenge. Curator has been used extensively on UK real-world data and can handle several linked datasets. However, for Curator to be accessed by a wider audience, it needs to become more user-friendly. Conclusion Curator has proven to be a cost-effective and trustworthy data curation tool, which should be developed further and made available to third parties

The global burden of fragility fractures – what are the differences, and where are the gaps

The current burden of fragility fractures is enormous, and it is set to increase rapidly in the coming decades as humankind enters a new demographic era. The purpose of this review is to consider, in different settings: • The human and economic toll of fragility fractures. • Risk factors for fragility fractures. • Current acute management of fragility fractures. • Current care gaps in both secondary and primary fracture prevention. A summary of global, regional, and national initiatives to improve the quality of care is provided, in addition to proposals for the research agenda. Systematic approaches to improve the acute care, rehabilitation and prevention of fragility fractures need to be developed and implemented rapidly and at scale in high-, middle- and low-income countries throughout the world. This must be an essential component of our response to the ageing of the global population during the remainder of the current United Nations – World Health Organization “Decade of Healthy Ageing”

An Evaluation of the ICD-10-CM System: Documentation Specificity, Reimbursement, and Methods for Improvement (International Classification of Diseases; 10th Revision; Clinical Modification)

The research project consists of three studies to identify the documentation specificity, reimbursement and documentation improvement for the upcoming International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) coding system. A descriptive research study using quantitative methods was conducted for the first study, which focused on coding electronic documents across each major diagnostic chapter for ICD-10-CM. The coding was ranked according to the Watzlaf et al (2007) study where a ranking score was provided if the diagnosis was fully captured by the ICD-10-CM code sets. The ICD-10-CM codes were then compared to the current ICD-9-CM codes to evaluate the details on the descriptions of the codes. The rankings were determined by comparing the ICD-10-CM systems for the number of codes, the level of specificity and the ability of the code description to fully capture the diagnostic term based on the resources available at the time of coding. A descriptive research study using quantitative methods was conducted for the second study, which focused on evaluating the reimbursement differences in coding with ICD-10- CM with and without the supporting documentation. Reimbursement amounts or the MS-DRG (Medicare Severity Diagnosis Related Groups) weight differences were examined to demonstrate the amount of dollars lost due to incomplete documentation. Reimbursement amounts were calculated by running the code set on the CMS ICD-10 grouper. An exploratory descriptive research study using qualitative methods was conducted for the third study which focused on developing a documentation improvement toolkit for providers and technology experts to guide them towards an accurate selection of codes. Furthermore a quick reference checklist geared towards the physician, coders and the information technology development team was developed based on their feedback and documentation needs. The results of the studies highlighted the clinical areas which needed the most documentation attention in order to accurately code in ICD-10-CM and the associated potential loss of revenue due to absent documentation. Further, the results from the educational tool kit could be used in the development of a better inpatient Computer Assisted Coding (CAC) product

A comparative effectiveness secondary data analysis: Selected short term economic and clinical outcomes of rapid surgical intervention in the geriatric fracture population

The percentage of the U.S. population that is over 65 years of age is expected increase to over 20% by 2040. Within that geriatric population, 50% of women and 20% of men will experience osteoporotic fractures. The cost of their care is estimated in billions of dollars annually. The outcomes from osteoporotic fractures account for more morbidity than all cancers, except lung cancer, combined. Rapid surgical intervention protocols, which reduce the time between fracture and surgical repair, are intended to improve outcomes and reduce costs. The protocols require intense care coordination and their effectiveness has not been unequivocally established. This study explored the relationships of rapid surgical intervention to the clinical outcomes of in-hospital delirium and pressure ulcer and the economic outcomes of post-procedure length of stay and total hospital charges. These outcomes were investigated through a secondary data analysis of the New York State administrative billing database (SPARCS) from a five-hospital system. The sample included 1,979 subjects from the years of 2010 through 2013; a modified Charlson Co-morbidity and Age Index score was applied to all subjects in order to approximate their admission health status. Rapid Surgical Intervention was a predictor (p \u3c .001) of lower post-procedure lengths of stay lower total hospital charges, and lower rates of pressure ulcer development. High Modified Charlson Index scores were predictive of higher mortality rates, longer lengths of stay, and higher total charges. Male gender was significant for higher lengths of stay, mortality rates, and pressure ulcer development. Femur/hip fractures were related to longer lengths of stay and higher total charges than other fracture sites, but were not a predictor of mortality or pressure ulcer development

Addressing Adherence to Bisphosphonate Medication Using a Systems-Based Approach

Primary non-adherence (PNA) to bisphosphonate medications has been recently identified to be as high as 30% in patients with osteoporosis or who are at risk for hip fracture. It is known that taking a bisphosphonate is the main course of defense in lowering patient risk and decreasing the hip fracture rate by 50%. However, if patients do not take their medication, they will not receive the benefit of fracture risk reduction that comes with it. This paper explored the testing and implementation of a protocol designed to improve the PNA rate and thus improve patient outcomes. This protocol used evidenced-based information that improved the provider-patient relationship through a telephone outreach protocol aided by a computer system that identified patients who had not picked up their medications from the pharmacy. The nurse practitioner (NP) coordinator targeted each patient and then worked the list of patients at risk until all patients had been contacted. The goal was to lower the PNA rate by 20% by targeting those patients who had not picked up their medications and by changing their behavior to develop an intention to pick up and take their bisphosphonate medication. This goal was reached as the PNA rate was reduced to 3.2%, although it might have been a combination of contributing factors that led to the decrease in rate and not the telephone outreach alone. The iv protocol was successful and was accepted into practice to be replicated throughout all of the medical centers within the organization

Developing Research Capacity in Swiss Chiropractic Primary Care Through Practice-Based Research Networks

please see pdf, too long to copy her