Optimizing Fracture Care Outcomes: A Comparative Effectiveness Approach Funded Grant uri icon

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  • SUMMARY (See instructions): The broad objective of the proposed research is to provide clinical comparative effectiveness evidence aimed at identifying the most effective approaches to post-fracture care with a focus on secondary fracture prevention. While there has been much interest in improving post-fracture bisphosphonate use, the incidence of second fracture is greatest early after the first fracture�a time period in which pharmacological osteoporosis treatment will have little impact. We currently lack evidence regarding which post-fracture practices will reduce both short- and long-term secondary fracture incidence. We also lack evidence on interventions that might mitigate poor outcomes among the sub-group of elders who may not survive long enough to benefit from osteoporosis treatment. These knowledge gaps will be addressed by evaluating alternative post-fracture care strategies, encompassing the full spectrum of care delivery and medication use, across health systems and regions where differences in post-fracture care exist. By studying the large national population of fracture patients cared for in diverse settings (using Medicare claims data and Centers for Medicare & Medicaid Assessment files for inpatient rehabilitation, skilled nursing facilities, nursing homes and home health, all linked to Part D pharmaceutical data), we will be able to identify correlates of safe, effective post-fracture care. A multidisciplinary team expert in comparative effectiveness research will characterize the impact of variation in care patterns on secondary fracture, mortality, and health care costs. Aim 1 will address 6-month risk of secondary fracture considering rehabilitation characteristics and use of drugs that increase fall risk. Aim 2 will extend examination of secondary fracture incidence to 1 -year when access and adherence to osteoporosis treatment will become important. Aim 3 will study outcomes among those at high-risk for mortality (e.g. nursing homes residents). Aim 4 will use decision-analytic modeling to quantify the potential clinical and economic value of alternative interventions to improve post-fracture care. By evaluating the impact of alternative post-fracture care strategies in this proposal, the long-term health and economic consequences of specific interventions in post-fracture care can be more fully understood.