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The National Audit of Falls and Bone Health in Older People

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Title: The National Audit of Falls and Bone Health in Older People


1
The National Audit ofFalls and Bone Healthin
Older People
insert name Strategic health Authority date,
venue
  • Speakers name and designation
  • On behalf of the Clinical Effectiveness and
    Evaluation Unit,
  • Royal College of Physicians, London
  • Funded by Healthcare Quality Improvement
    Partnership

2
Commissioning A Systematic approach to falls
bone health Four key objectives
3
How do we know how we are doing?
  • We can only be sure to improve what we can
    actually measure
  • Lord Darzi, High Quality Care for All, June 2008

4
Clinical audit evaluation
Evidence based standards
National Hip Fracture Database
BOA/BGS Blue Book High quality hip fracture care
Blue Book, NSF, NICE Fracture Liaison
Service Falls Clinic
National Audit of Falls and Bone Health
NSF, NICE Exercise programmes Falls
clinics Bisphosphonates
NSF Health promotion
Where audit fits in this model
5
National Clinical Audit 2007 Sample and Results

3184 hip fractures Mean age 83, 80 women 57 left AE within 4hrs (target 100) 87 to specialist ward --------------------------------- Mean LOS 16 days 25 gt 26 days 59 back to usual residence 27 to intermediate care bed 5642 non-hip fractures Mean age 79, 86 women 64 attended in office hrs 1/3 admitted 96 of the rest went home ------------------------------------- Integrated acute-community pathways are needed
6
Hip fracture management
  • Pre-operative management was generally good for
    pain relief, fluids, routine observations
  • only 46 pressure risk assessments, 54
    mattresses
  • Surgery within 24h - 35, 48h - 69
  • Organisational delay was responsible for 29
  • Low rates of routine medical review
  • Lack of acute orthogeriatric services
  • Only 39 had multidisciplinary team review within
    1st week

7
Secondary prevention - Bone health Hip fracture
v Non-hip fragility fracture
50 osteoporotic
8
n 7860/31094
n 1476/15025
n 2551/15025
n 1862/2551
n 261/14651
n 700/14651
n 305/700
Hippisley-Cox, J., Bayly, J., Potter, J., Fenty,
J. Parker, C. (2007) Evaluation of standards of
care for osteoporosis and falls in primary care.
The Health and Social Care Information Centre.
9
Secondary prevention - Falls risk assessment Hip
fracture v Non-hip fragility fracture
10
Aspects of integrated falls care in patients 75
and over (n 270,028)
n 1,076 / 251,049
n 1,335
n 15
n 10
n 319
Hippisley-Cox, J., Bayly, J., Potter, J., Fenty,
J. Parker, C. (2007) Evaluation of standards of
care for osteoporosis and falls in primary care.
The Health and Social Care Information Centre.
11
Secondary prevention
  • Most patients receive inadequate secondary
    prevention so are at unnecessarily greater risk
    of further harm
  • Non-hip fragility fracture patients receive less
    attention than hip fracture patients

12
The Second National Audit of the Organisation of
Services for Falls and Bone Health in Older
People (2008)
13
Participation
  • Acute trusts 100 (158/158)
  • Primary Care Organisations 88 (150/171)
  • Health Social Care Trusts 88 (7/8)
  • Mental Healthcare Trusts 76 (44/58)
  • Care homes 73 homes
  • (sample drawn from 2 national providers)

14
Key Results

15
Commissioning for falls and bone health
TAG 87 National Institute for Health and
Clinical Excellence, Technology Appraisal
Guidance, Number 87
16
Acute trusts - case finding
17
Secondary prevention of falls
18
Key Messages
19
Services fail to achieve evidence based standards
  • Services are variable in quality and many lack
    key evidence based components
  • Lack of integration between falls services and
    fracture services
  • Significant gaps along patient journey for falls
    and fractures
  • Inadequate levels of secondary prevention for
    both falls and bone health
  • Secondary prevention for non-hip fragility
    fracture is less good than for hip fracture

20
Opportunities to prevent recurrent falls and
fractures are being missed
  • Risk assessments in AE departments and Fracture
    services are inadequate
  • Services with Falls Coordinators and Fracture
    Liaison Nurses have better case finding systems
    in place to identify high risk fallers
  • Many trusts do not provide these important posts
  • Many of the exercise programmes being provided
    are not evidence based
  • Services for bone health appear less well
    developed than services of falls prevention
  •  

21
Commissioning for falls and bone health is weak
  • Only 64 (110/171) of commissioning bodies have a
    written strategy on falls prevention
  • Only 23 (38/171) have a strategy for bone health
  • Important public health information on fracture
    rates is inadequate or not collated
  • Only 39 (67/171) of commissioning trusts report
    having a mechanism to assess local compliance
    with national guidelines on osteoporosis treatment

22
Thank You
23
Falls risk assessment
Falls history Syncope considered Medication reviewed CVS examination Vision assessment Vision impaired Gait balance assessed Exercise programme Home hazard assessed Non-Hip () 25 17 31 40 10 38 (most treated) 28 22 14 Hip () 45 22 44 89 19 40 (most treated) 68 44 51
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