‘Blue Book’ for Fragility Fractures Features Best Practices

From left: Daniel A. Mendelson, M.D., Stephen L. Kates, M.D., and Susan M. Friedman, M.D.

Daniel A. Mendelson, M.D., Stephen L. Kates, M.D., and Susan M. Friedman, M.D.

The United States’ first “Blue Book” for fragility fractures published in February, edited by Stephen L. Kates, M.D., associate professor in the Department of Orthopaedics, and Simon C. Mears, M.D., Ph.D., associate professor of Orthopaedic Surgery, Johns Hopkins Hospital.

URMC faculty Susan V. Bukata, M.D., Susan M. Friedman, M.D., Daniel A. Mendelson, M.D., and Wakenda K. Tyler, M.D., and Chief Resident Fernando H. Serna Jr., M.D., are among the contributors.

The publication offers a comprehensive look at current best practices in the care and prevention of fragility fractures. Although the United Kingdom has had a Blue Book for fragility fractures for the past eight years, A Guide to Improving the Care of Patients with Fragility Fractures is the first of its kind for physicians, nurses, therapists and students written for the U.S. health care market.

The new guide is published as the third issue of Geriatric Orthopaedic Surgery & Rehabilitation, a journal devoted to orthopaedic care for elderly patients that debuted in September 2010. Kates is founding editor of the journal, which is published by SAGE Publications, a leading independent academic and professional publisher.

Kates, Mendelson and Friedman published two peer-reviewed studies in the journal’s debut issue. Their work built on existing evidence that the Geriatric Fracture Center (GFC) approach – medical co-management of elderly fracture patients using standardized protocols – significantly improves patient outcomes and can lower the cost of care.

In previous studies published in Archives of Internal Medicine, Journal of the American Geriatrics Society and Osteoporosis International, the GFC team demonstrated that medical co-management and standardized care yield better patient outcomes – shorter lengths of stay, fewer complications, and fewer hospital readmissions. The impact of this approach on short-term results has been well documented; the team’s newest studies show how profound the benefits of this approach can be.

Their most recent research indicates that elderly fracture patients live longer and their cost of care is far lower – about $18,000 lower per patient, compared to the national average – when they get the kind of care offered at Highland Hospital’s Geriatric Fracture Center.

The lower costs can be attributed to eliminating inappropriate medication and tests, fewer infections and complications that require additional treatment and less time in the hospital. GFC patient stays average 4.6 days, compared to the national average of 6.2 days.

Kates, Mendelson and Friedman are active in sharing the benefits of their approach with physicians around the world. They regularly teach physicians in the United States, Europe, Asia and South America about the GFC model. In the United States, 295 hospitals are replicating the GFC approach to care; hospitals in Basel, Switzerland; Innsbruck, Austria; Augsburg, Germany; Hong Kong and Singapore have also implemented the program.

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