Improving Follow-up Care for Fragility Fractures: An Evidence-based Practice Initiative

Date of Completion

January 2010


Health Sciences, Nursing




The goal of this quality improvement project was to delineate an evidence-based practice initiative at a university health center to improve patient follow-up care after fragility fractures. Patients with fragility fractures are at risk for recurrent fracture, and inadequate follow-up care for patients with fragility fractures was identified as a problem. Prevention of future fractures through appropriate patient follow-up can decrease annual health care expenditures, and decrease patient morbidity and mortality. A review of the literature revealed a significant evidence base supporting appropriate follow-up, including notification of the patients' primary care provider of the fracture and the follow-up plan, ordering a bone density scan within 3 months of the time of the fragility fracture diagnosis, and making a formal referral to the osteoporosis center for consultation. A description of the problem and the significance to health care is discussed, including baseline data for current follow-up practices. A plan for improving patient outcomes for follow-up care of fragility fractures was developed utilizing the Iowa Model of Evidence-Based Practice to Promote Quality Care. The evidence-based initiative was implemented, and the outcomes assessed. The results were that 100% of patients received adequate follow-up after fragility fractures, and this was accomplished using the Iowa Model to promote an evidence-based change initiative and through the role of a change champion. The change champion was a nurse practitioner in the orthopedic clinic, and a Doctor of Nursing Practice (DNP) student. ^