Patient navigation improves outcomes in various clinical contexts, but has not been evaluated in secondary fracture prevention.
We retrospectively reviewed charts of patients, age 50 + from April to October, 2016 hospitalized with fragility fracture contacted by a patient navigator. Patients were identified using an electronic tool extracting data from electronic medical records which alerted the patient navigator to contact patients by phone post-discharge to schedule appointments to “High-Risk Osteoporosis Clinic” (HiROC) and Dual-energy X-ray Absorptiometry (DXA) scan. Primary outcome was transition from hospital to HiROC. We also compared completion of DXA, five osteoporosis-associated in-hospital laboratory tests (calcium, 25-hydroxy vitamin D, complete blood count, renal, and liver function), osteoporosis medication prescription and adherence, and other patient characteristics to historical controls (2014–2015) without patient navigation. Comparisons were made using Chi-square, Fisher’s Exact, two-sample t test or Wilcoxon Rank Sum test, as appropriate.
The proportion of patients transitioning to HiROC with and without patient navigation was not different (53% vs. 48%, p = 0.483), but DXA scan completion was higher (90% vs. 67%, p = 0.006). No difference in medication initiation within 3 months post discharge (73% vs. 65%, p = 0.387) or adherence at 6 months (68% vs. 71%, p = 0.777) was found. Patients attending HiROC lived closer (11 vs. 43 miles, p < 0.001) and more likely to follow-up in surgery clinic (95% vs. 61%, p < 0.001).
Patient navigation did not improve transition to HiROC. Longer travel distance may be a barrier—unaffected by patient navigation. Identifying barriers may inform best practices for Fracture Liaison Service programs.
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The project described was funded by The Ohio State University Self Insurance Program (USIP) and supported by NIH Award Number UL1TR002733 from the National Center For Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the USIP, Wexner Medical Center, National Center For Advancing Translational Sciences or the National Institutes of Health.
Conflict of interest
KQJ, LS, LP, and JS declare they have no conflict of interest. SWI has received research grants from Alexion, Radius, Takeda/Shire, Ultragenyx; honoraria for ad hoc advisory board participation from Alexion and Takeda/Shire; and honoraria for speaking at Interdisciplinary Symposium on Osteoporosis by National Osteoporosis Foundation.
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Jia, K.Q., Southerland, L., Phieffer, L. et al. Incorporation of a patient navigator into a secondary fracture prevention program identifies barriers to patient care. Aging Clin Exp Res 32, 2557–2564 (2020). https://doi.org/10.1007/s40520-020-01486-3
- Patient navigation
- Post-discharge clinic transition
- Osteoporosis management
- Fracture liaison service