3788 Multi-stakeholder approach: building on existing quality initiatives to improve 52-week follow-up based on FLS-DB guidance

Introduction Fracture liaison services (FLS) aim to prevent secondary fractures by promptly identifying patients above 50 years with fragility fractures. The standard recommendation by FLS Database (FLS-DB) is to identify 80% expected fragility fractures, commencing treatment for 50% and monitor 80% at 52 weeks. Methods A quality improvement methodology based on the model of improvement; Plan-Do-Study-Act (PDSA) cycles was introduced in 2022. The fragility fracture case identification increased from 22.7% (2021) to 41.1% (2022) and 58.4% in 2023, a 149% increase. Process mapping for the Aneurin Bevan FLS (AB-FLS) showed that follow-up clinics were only ad-hoc and not formalised. A separate clinic code for annual review of patients, led by Speciality Geriatric Trainee was tested in 2023. One-year follow-up clinic streamlined service and improved performance to 25.9% (360 cases) in 2023, just above the national benchmark (24.2%). Our objective is to introduce multi-stakeholder involvement to further improve and sustain 52-weeks follow-up improvement to meet the service demand and national target. Results Multiple PDSA cycles led to AB-FLS Quality Assurance group including clinicians, Pharmacist, Primary Care General Practitioner as Influencers and three Patient Representatives. Team met formally every 3 months to review interventions and introduce changes. Challenges were overcome by providing a dedicated 52-weeks follow-up clinic. In addition, engagement with Primary Care for longer-term osteoporosis care unless requiring specialist bone health reviews is ongoing. In 2024, AB-FLS identified 2620 cases (70%; National benchmark = 39.9%) and commenced bone treatment for 1611 cases (61.5%; National Benchmark = 56.4%). The 52-weeks follow-up improved from 25.9% (360 cases) in 2023 to 62.7% (1010 cases) in 2024, which is more than double the national benchmark (24.2%). Conclusion This work is aligned with Welsh Prudent Healthcare principles of evidence-based medicine, partnership working with patients and meeting the unmet needs of the most vulnerable. Collaborative efforts with diverse stakeholders including primary care and patient representative have improved 52-week follow-up in 62% fracture patients. The success of this multi-stakeholder quality initiatives offers compelling evidence that this model is scalable across Wales, providing a sustainable and impactful solution to managing osteoporosis and preventing secondary fractures.