2025 US Fracture Care Coordination Survey

On behalf of the International Geriatric Fracture Society (IGFS, www.geriatricfracture.org) and Fragility Fracture Network USA (FFN USA), thank you for completing this survey on the status of your fracture care coordination program. This survey will be open through Tuesday, September 30, 2025.

Please note that your responses will be anonymized and only summary data will be shared publicly - it is estimated that completion of this survey will take 12-15 minutes.

For the purposes of this survey, we are looking for information on the following types of fracture care coordination programs at your institution:

1. In-patient orthogeriatric/geriatric co-care fracture prevention programs (a multi-disciplinary program which strive to improve overall outcomes (morbidity, mortality, and/or physical function) for patients requiring orthopaedic surgery for their fragility fracture)

2. Out-patient post-fracture care/Fracture Liaison Service programs (a systematic, coordinated care program that identifies, evaluates, and manages patients who have sustained a fragility fracture with the goal of preventing future fractures)

For more background on the terms used in this survey, please refer to the following publication:
Post-fracture care programs for prevention of subsequent fragility fractures: a literature assessment of current trends [https://pmc.ncbi.nlm.nih.gov/articles/PMC8943355/]

Founded in 2012, IGFS is a non-profit organization whose mission is to drive the delivery of evidence-based, patient-centered care for the treatment of geriatric or fragility fractures. The organization became recognized as the US chapter of the Fragility Fracture Network in 2023.

DEMOGRAPHICS

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* 1. Name:

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* 2. Institution/Practice Name:

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* 3. Specialty:

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* 4. Email Address (requested so we can share final survey results):

INSTITUTIONAL/ORGANIZATION INFORMATION

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* 5. Institution/Organization/Practice Type:

Academic medical center/teaching hospital

Community hospital

Long-term care hospital/skilled nursing facility (SNF)

Rehabilitation hospital (not part of the SNF)

Out-patient clinic

Group or private practice (office-based)

Home health

Acute/urgent care (clinic-based)

Other (please specify)

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* 6. If this survey should be sent to someone else at your organization, please enter their name and email address (the person involved with or responsible for your institution’s/practice fracture prevention program(s)):

Name

Email Address

QUALITY MEASURES/OUTCOMES REPORTING

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* 7. Does your institution currently report to the Center for Medicare & Medicaid Services its performance around the Age Friendly hospital measure (which is a mandatory measure to report starting in 2025 - see https://public-inspection.federalregister.gov/2024-17021.pdf)?

Yes

Don't Know

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* 8. Does your institution/organization/practice systematically collect quality measures or outcomes regarding the care you provide for fractures?

Yes

Don't Know

If yes, which quality measures/outcomes?

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* 9. Does your institution see patients for osteoporosis evaluation before spine surgery, hip/knee replacement surgery, or other orthopaedic/neurosurgical procedures?

Yes

Don't Know

If yes, please describe in further detail.

IN-PATIENT/OUT-PATIENT FRACTURE PREVENTION PROGRAM

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* 10. How are patients typically referred to your in-patient or out-patient program?

Automatic electronic medical record alert/referral

Provider-initiated referral

Manual chart review

Other (please specify)

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* 11. Is there a standardized discharge process for patients with fragility fractures to ensure continuity of care?

Yes, standardized across institution

Yes, but varies by department/provider

Don't know

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* 12. How is your in-patient or out-patient fracture care program currently funded (select all that apply)?

Hospital/institutional budget

Grant-funded

Reimbursement through billing codes (e.g., CMS/bundled payment programs)

Philanthropy

Not formally funded

Other (please specify)

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* 13. Do you face any barriers to implementing or sustaining your in-patient or out-patient fracture care coordination program (check all that apply)?

Staffing limitations

Lack of leadership support

Financial constraints

Limited reimbursement

Electronic medical record/data integration challenges

Competing institutional priorities

Other (please specify)

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* 14. Are there disparities in access to your in-patient or out-patient fracture care program based on the patient’s insurance type, language, race/ethnicity, or geographic location?

Yes

Don't know

If yes, please explain:

IN-PATIENT ORTHOGERIATRIC/GERIATRIC CO-CARE FRACTURE PREVENTION PROGRAM

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* 15. Do you have an in-patient orthogeriatric/geriatric co-care program at your institution/organization/practice?

Yes

Don't Know

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* 16. If applicable, which disciplines are involved in this orthogeriatric/geriatric co-care program (please check all that apply)?

Orthopaedics

Geriatrician

Internist

Endocrinologist

Rheumatologist

Other medical provider

Nurse

Nurse practitioner

Physician assistant/associate

Physical therapist

Occupational therapist

Social worker

N/A

Other (please specify)

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* 17. When did the orthogeriatric/geriatric co-care program start at your site (month/year) or N/A?

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* 18. If you do not have an orthogeriatric/geriatric co-care program at this time, do you plan on starting one by the end of 2025?

Yes

Don't Know

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* 19. Do you plan to start an orthogeriatric/geriatric co-care program in 2026 or beyond?

Yes

Don't Know

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* 20. Do you currently have a mechanism to transfer patients (internally or externally) to a rehabilitation program that helps patients recover after a surgery for a fracture (i.e., a structured protocol to refer patients to physical or occupational therapy to facilitate their recovery)?

Yes

Don't Know

OUT-PATIENT POST-FRACTURE CARE/FRACTURE LIAISON SERVICE PROGRAM

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* 21. Do you currently have an out-patient post-fracture/Fracture Liaison Service (FLS) care coordination program?

Yes

Don't Know

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* 22. If you do not have a out-patient post-fracture/FLS program at this time, does your institution/organization/practice plan on starting one by the end of 2025?

Yes

Don't Know

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* 23. Do you plan to start a out-patient post-fracture/FLS program program in 2026 or beyond?

Yes

Don't Know

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* 24. When did the out-patient post-fracture/FLS program start at your site (month/year) or N/A?

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* 25. How long are patients followed by your out-patient FLS program?

3 months

1 year

Longer than 1 year

N/A

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* 26. Do you use your electronic medical record to support your out-patient post-fracture/FLS program (e.g., clinical decision support, care pathways, documentation templates)?

Yes

Don't know

If yes, please specific how:

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* 27. Does your out-patient post-fracture/FLS program integrate with your electronic health record system?

Yes

Don't know

If yes, please specific how:

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* 28. Are there barriers to implementing or expanding your out-patient post-fracture/FLS program (please describe below)?

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* 29. Has the person who is running your out-patient post-fracture/FLS program had specific training in this field?

Yes

Don't know

If so, in what form (i.e., classes, courses, curriculum)?

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* 30. Does your out-patient post-fracture/Fracture Liaison Service (FLS) coordination program also help patients connect with a primary care provider after discharge from your facility or organization?

Yes

N/A

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* 31. Which outcomes does your out-patient post-fracture/Fracture Liaison Service program track (check all that apply)?

30-day hospital readmission

1 year mortality

Repeat fracture

Medication adherence

Osteoporosis diagnosis and treatment initiation

Patient-reported outcomes (i.e., fracture, mobility, pain)

None of the above

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* 32. Does your out-patient post-fracture/FLS coordination program arrange for patients to receive rehabilitative care in a facility or from a physical therapist/assistant or occupational therapist/assistant in an out-patient setting?

Yes

N/A

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* 33. Describe the elements of your out-patient post-fracture/FLS program (check all that apply):

Our program systematically IDENTIFIES when a fragility or vertebral fracture has occurred and that further patient assessment is needed.

Our program INVESTIGATES (through bone mineral density or other imaging techniques, laboratory and pathology tests, and/or other means) each patient’s future fracture risk and develops a diagnosis and care plan.

Our program INITIATES osteoporosis treatment when appropriate.

Our program MANAGES long-term osteoporosis treatment without referral to another practice.

Our program FOLLOWS UP with patients on osteoporosis therapy at regular intervals.

Our program MAINTAINS A PATIENT REGISTRY to track our patient population.

N/A

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* 34. What percentage of patients with suspected fragility fractures is your out-patient post-fracture/FLS program able to identify and capture for screening, diagnosis and treatment (if needed)?

100

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 35. Which types of fracture patients does your out-patient post-fracture/FLS program identify (check all that apply)?

Hip fracture

Fragility fractures (in-patient treated) in orthopaedic/trauma/emergency department

Fragility fractures (out-patient)

Radiologically identified vertebral fractures

N/A

Other fractures or additional comments (please specify)

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* 36. Does your out-patient post-fracture/FLS program have a post-fracture/FLS coordinator?

Yes

Don't know

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* 37. If your out-patient post-fracture/FLS program has a post-fracture/FLS coordinator, please specify their specialty:

Nurse Practitioner

Physician Assistant/Associate

Registered Nurse

Don't know

Other (please specify)

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* 38. If your out-patient post-fracture/FLS program has a post-fracture/FLS coordinator, please describe below what types of FLS/osteoporosis education he/she has received and how knowledgeable the coordinator is on the osteoporosis disease state, evaluation/diagnosis, and treatment.

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* 39. What is the specialty of your out-patient post-fracture/FLS program physician champion?

Endocrinology

Geriatrics

OB/GYN

Orthopaedics

Primary Care

Rheumatology

Internist

Don't know

Other (please specify)

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* 40. Is there any other information on your fracture prevention care coordination work you would like to share with IGFS/FFN USA?

Thank you for taking the time to complete this important survey. Should you have any questions, do not hesitate to contact IGFS/FFN USA Executive Director Fraser Cobbe (fcobbe@cobbemanagement.com).

To learn more about IGFS and FFN USA, please visit our website at www.geriatricfracture.org.