Date of Graduation

Summer 8-6-2025

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

Kaiser cohort MSN capstone

First Advisor

Cathy Coleman

Second Advisor

Sarah Horton-Deutsch

Abstract

Problem Osteoporotic fractures are a major public health concern in the United States; 1 in 2 women and 1 in 4 -5 men will experience a fracture due to low bone density. Despite established clinical guidelines, many patients in this managed care health system do not receive timely osteoporosis screening or treatment, placing them at increased risk for costly readmissions averaging $50,000 per hospitalization especially among those discharged to skilled nursing facilities.

Context The improvement project targeted patients admitted with fractures and integrated DEXA scanning during the acute care stay to avoid delays in diagnosis and bisphosphonate therapy. Barriers included limited access to inpatient DEXA scans and inadequate follow-up after discharge.

Interventions A collaborative, redesigned workflow to improve outcomes and reduce costs was implemented over 4 months.

Measures Outcome measures were derived from the Healthcare Effectiveness Data and Information Set (HEDIS), for fracture prevention in older adults. HEDIS measures aim to ensure that patients, particularly women aged 65 and older receive osteoporosis evaluation and treatment within 6 months of a fracture. The current score at this facility is 69% capture rate for treatment or screening as measured by the HEDIS metric, which falls short of the established target of 82% and this organization’s 90% regional goal.

Conclusions Aligning outpatient disease management interventions with inpatient workflows offers the opportunity to improve both patient and organizational outcomes such as readmission reduction and patient satisfaction. Nurse leaders need to explore creative and cost-effective options for reducing morbidity associated with fracture prevention programs.

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