SAT-LB089 Incorporation of a Patient Navigator into a Secondary Fracture Prevention Program Identifies Barriers to Patient Care

Incorporation of a Patient Navigator into a Secondary Fracture Prevention Program Identifies Barriers to Patient Care Abstract Introduction: Patient navigation has emerged as a valuable component to improve patient outcomes in the outpatient setting. We investigated the effect of patient navigation in transitioning patients hospitalized for acute fracture to an outpatient clinic for secondary fracture prevention, and explored factors associated with successful transition. Methods: This study was a retrospective chart review of patients, age 50+ from April to October, 2016 hospitalized with fragility fracture at our medical center who were contacted by a patient navigator. We created an electronic tool that extracted data from the electronic medical record alerting the patient navigator to contact the patient by phone to schedule an outpatient appointment into an osteoporosis clinic as well as a Dual-energy X-ray Absorptiometry (DXA) scan. Patient outcomes of transition from hospital to outpatient clinic, completion of DXA scan, completion of all five osteoporosis-associated laboratory tests (calcium, 25-hydroxy vitamin D, complete blood count, renal function, liver function), and osteoporosis medication prescription and adherence, as well other patient characteristics were compared to patients from a historical control period (2014-2015). This group consisted of a similar patient population seen without assistance of a patient navigator. Categorical variables were compared using Chi-square or Fisher’s Exact tests and continuous variables were compared with a two-sample t-test or a Wilcoxon Rank Sum test. We also explored potential factors which might predict barriers to successful outpatient clinic transition using a univariate logistic regression. Results: The proportion of patients who successfully transitioned to osteoporosis clinic modestly improved with the use of a patient navigator versus control (53% vs. 48%, p=0.048). DXA scan completion was higher with patient navigation (90% vs. 67%, p=0.006). No difference in osteoporosis medication initiation within 3 months post discharge (73% vs. 65%, p=0.387) or medication adherence at 6 months (68% vs. 71%, p=0.777) was found between the two groups. Patients who followed up in clinic lived closer (11 vs. 43 miles, p<0.001) and were also more likely to follow up in orthopedic surgery clinic for post-fracture care (95% vs. 61%, p<0.001). Conclusion: A modest improvement in the proportion of patients who transitioned to an outpatient clinic for osteoporosis care was achieved with the use of patient navigation compared controls. We found a longer travel distance may be a barrier to transitioning to clinic. Identifying such barriers may help inform future refinements for fracture liaison and patient navigation service programs resulting in changes in best practices that improve patient outcomes. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.