Park Nicollet Methodist Hospital
Own the Bone® Case Study
By Marc F. Swiontkowski, MD
September 2010
AOA got involved in trying to improve care for fragility
fractures about five years ago. As an organization, we
recognized both the clinical need and why an improved connection
between orthopaedic surgeons and the subsequent management of
patients with fragility fractures was necessary. The Own the
Bone program was developed as a result.
University of Minnesota was one of twelve pilot sites to
investigate the effectiveness of this intervention and study
results demonstrated how we improved all the major metrics of care
for patients admitted with fragility fractures. After the
pilot, I met with rheumatologist Dr. John Schousboe at Park
Nicollet Methodist Hospital who had documented the same gap with
follow-up care for fragility fracture patients that been measured
and reported elsewhere. Dr. Schousboe had found that only 12%
of patients following admission for hip fractures were getting
appropriate screening and management. He had tried on his own
to improve communications with general medical services in the
orthopaedics department but after 18-24 months of frustration he
had basically given up. So when he heard of this program he
agreed that it should be implemented at Park Nicollet and we were
the first center that enrolled in Own the Bone.
At Park Nicollet, we see 350 patients with hip fractures alone
each year and in the first year using this tool, the 12% of
patients getting appropriate screening and subsequent care went up
to 80%. We have a discharge planning nurse who works with the
total joint patients (we have about 1000 patients per year being
admitted for total hips and total knees). Her role is to
identify patients that have admitted with fragility fractures and
to do the appropriate screening and data entry and she devotes
about a day a week to this program. Basic laboratory testing
is done and at discharge a DXA scan is set up for the same day as
the six-week visit. I see patients at the six-week visit and
I review the results with the patient and their family and decide
appropriate therapy. We use a basic algorithm that been
approved by the NOF on how to recommend treatment. Patients
who appear to need more than the basics are seen by rheumatologist
Dr. Schousboe who has a special interest in osteoporosis. A
nurse works alongside me and handles data entry for the six-week
visit based off the dictation that is done.
We have been in the program for just over a year. Over
time our discharge planning nurse has become more comfortable with
the program and it has taken her less time to implement; it is
actually 52 clicks to enter a single patient's data. While we
still have work to do (we are streamlining the process on the
six-week visit and subsequent follow-up to make sure that we are
involving primary care in decision-making about therapy), we think
after another year or two we should have the system functioning at
a very high level of efficiency.
