Bone Abstracts

Background: Osteoporosis is a chronic condition that often remains undiagnosed until a fragility fracture occurs. In 2023, a Welsh ministerial mandate established a national expectation that all patients presenting with fragility fractures receive standardised, high-quality care aligned with Fracture Liaison Service (FLS) recommendations and Royal Osteoporosis Society standards. To support these aims, Welsh osteoporosis services have adopted Value-Based Healthcare (VBHC) principles, placing patient outcomes, experiences and priorities at the centre of care. This project explored how Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs) can be integrated into patient education pathways to personalise care, support self-management and improve long-term treatment adherence.

Methods: A collaborative pilot was undertaken between VBHC and Education Programme for Patients (EPP) Cymru. Through patient engagement and “What Matters” conversations, service gaps and patient priorities were identified and incorporated into care planning. PREMs and PROMs informed the development of a VBHC osteoporosis dashboard capturing patient experience, health outcomes, medication adherence, health-related quality of life and outcomes important to patients. A bespoke osteoporosis self-management programme was co-designed by patients, clinicians and EPP Cymru. The programme was evaluated using the validated EDUCATOOL questionnaire. Quality improvement methodology was applied through three sequential Plan-Do-Study-Act (PDSA) cycles.

Results: PROM analysis of 188 FLS patients shows lack of understanding of FLS and Osteoporosis. Improvements were observed in self-care (31.3%), usual activities (42.0%) and physical activity (27.7%). Patients’ adherent to medication showed favourable outcomes across all measured domains, whereas non-adherent patients experienced declines in mobility and wellbeing. Seventeen participants attended the first six-week educational programme. EDUCATOOL evaluation demonstrated high levels of satisfaction and perceived benefit (total score 94.2±6.5/100). Patient feedback identified opportunities for improvement, including enhanced nutritional guidance, addressing fear of falling and increasing physical activity components. Subsequent programme modifications included education on vitamin D, calcium and protein intake, use of a calcium calculator, tailored and chair-based yoga, and dedicated DXA education sessions. Re-evaluation following these changes demonstrated sustained high scores (93.1±7.4/100), indicating maintained participant satisfaction while addressing patient-identified needs.

Conclusions: PROMs and PREMs played a pivotal role in personalising osteoporosis education pathways and informing service redesign. The integration of patient-reported data enabled responsive quality improvement, supported shared decision-making and identified population groups requiring tailored interventions. This VBHC approach demonstrates the potential of combining patient experience and outcome measures to enhance post-fracture care and improve long-term osteoporosis management across Wales.