What are the categories of post-fracture care programs based on patient location, specifically inpatient (hospital-based) or outpatient (clinic-based) settings?

From the Guidelines

Post-fracture care programs are categorized as either inpatient or outpatient based on the setting where treatment is delivered, with inpatient programs occurring in hospitals or rehabilitation facilities and outpatient programs taking place in clinics or at home. This distinction is crucial as it reflects the intensity of care needed, with inpatient programs generally serving patients with more complex fractures or comorbidities requiring continuous monitoring, while outpatient programs are designed for those with stable fractures who can safely recover while living at home 1. The setting determines the frequency of professional oversight, available resources, rehabilitation protocols, and ultimately influences patient outcomes and recovery timelines.

Key Considerations

• Inpatient programs are typically used for patients with complex fractures or comorbidities that require close monitoring and intensive care 1.
• Outpatient programs are suitable for patients with stable fractures who can recover at home with less frequent professional oversight 1.
• The Fracture Liaison Service (FLS) model has been shown to be an effective organizational structure for risk evaluation and treatment initiation, with a dedicated coordinator overseeing the process 1.

Implications for Care

• The choice between inpatient and outpatient care should be based on the individual patient's needs and fracture complexity, rather than solely on the location where care is delivered.
• A systematic approach to evaluating fracture risk and initiating treatment, such as the FLS model, can improve patient outcomes and reduce the risk of subsequent fractures 1.
• Effective communication and collaboration between healthcare providers, including orthopaedic surgeons, endocrinologists, rheumatologists, and primary care physicians, are essential for optimal post-fracture care 1.

From the Research

Post-Fracture Care Programs

The categories of post-fracture care programs based on patient location can be divided into two main settings:

• Inpatient (hospital-based) settings
• Outpatient (clinic-based) settings

Inpatient Settings

Inpatient post-fracture care programs are typically provided in hospitals or rehabilitation facilities, and may include:

• Intensive rehabilitation pathways, which have been shown to lead to better results in terms of recovering Activities of Daily Living 2
• Extensive rehabilitation pathways, which are often the most common type of post-hospital care pathway 2

Outpatient Settings

Outpatient post-fracture care programs are typically provided in clinics or community-based settings, and may include:

• Fracture liaison services (FLS), which have been shown to enhance the initiation of and adherence to secondary prevention of fragility fractures 3, 4
• Geriatric/orthogeriatric services, which are often used in conjunction with FLS to provide comprehensive care to patients with fragility fractures 3
• Patient-centered care programs, which have been shown to improve post-fracture bone mineral density (BMD) investigation and treatment prescription 5

Key Characteristics of Post-Fracture Care Programs

Some key characteristics of post-fracture care programs include:

• Early mobilization and fall risk assessment 4
• Initiation of adequate bone-specific medication 4
• Monitoring of patients to increase adherence to bone-specific medication and fall prevention strategies 4
• Coordination of care by a multidisciplinary team 4