Greenville Hospital System University Medical Center
Own the Bone® Case Study
By Kyle J. Jeray, MD
August 2010
In 2004, the American Orthopaedic Association's (AOA) leadership
identified as a critical issue the huge treatment gap that was
highlighted in the 2004 Surgeon General's report, detailing the
poor management of osteoporosis care for patients who have suffered
a fragility fracture. As an orthopaedic leadership
organization, the AOA came to the conclusion that orthopaedic
surgeons have a great opportunity to address this critical issue in
bone health. To address this issue, the AOA's Own the Bone
Steering Committee developed a pilot program involving fourteen
institutions. The pilot program was pronounced a success by
the participating institutions and the research from the pilot was
published in the Journal of Bone and Joint Surgery (JBJS). In
2009, the Own the Bone program was launched as a national fragility
fracture prevention program.
The Greenville Hospital System joined Own the Bone to address
this critical issue in bone health. Patients admitted to the
Greenville Hospital and other institutions with a fragility
fracture often have low bone mineral density and
osteoporosis. In many cases, after the patient is treated and
discharged for the fracture, the patient returns within a few
months with a secondary fracture. Own the Bone is a tool that
is designed to disrupt this cycle by identifying, evaluating and
treating patients with low bone mass and osteoporosis to reduce the
risk of secondary fractures.
At Greenville, when a patient has been identified as 50 years or
older and presents with a fragility fracture, the nurse
practitioner assigned to Own the Bone is contacted. The nurse
practitioner downloads a one-page two-sided note-taking form off
the registry to evaluate the patient. To avoid unnecessary
duplication in the data entry process, Greenville has created a
checkbox within their electronic medical records to ensure that Own
the Bone works in conjunction with Own the Bone within its
system. The Greenville medical staff checks the box within
the electronic medical records system to indicate that a patient
has been entered into Own the Bone and to create reminders for DXA
and follow-up appointments.
After the information has been collected, the nurse practitioner
provides the patient with education materials that can also be
found on the registry. As Dr. Marc Swiontkowski from Park
Nicollet Methodist Hospital has stated, it takes about 52 clicks to
enter a patient into the registry. When subscribers become
more proficient at entering patients into the registry it takes
only 3 to 4 minutes to complete a patient enrollment.
The registry also allows Own the Bone subscribers to download
patient and physician letters. The physician letters contain
specific information related to the patient and are meant to inform
the primary care physician about the fragility fracture and the
recommended treatment. The patient letters include additional
patient education about low bone mass/osteoporosis and
recommendations. The letters are customizable and generated
in a Word template to fit each institution's needs. For
instance, at Greenville, the patient letters are customized to
connect the patients to their primary care physician.
Greenville is working on incorporating several specialty groups
together including nurse practitioners, rheumatologists, internal
medical, and primary care physicians to focus on bone health
issues. As the patient is discharged from Greenville, a DXA scan is
scheduled. The AOA recommends a 90-day follow-up with
patients who are discharged. The necessary follow-up is made
with either the primary care physician or in some cases with the
orthopedist.
