Health Service Use and Quality of Life Recovery 12 Months Following Major Osteoporotic Fracture: Latent Class Analyses of the International Costs and Utilities Related to Osteoporotic Fractures Study (ICUROS).

Major osteoporotic fractures (MOFs) are associated with a rapid decline in health-related quality of life (HRQoL); however, there is limited knowledge about which healthcare services positively affect HRQoL postfracture. This study aimed to identify specific combinations of health service use associated with recovery of HRQoL 12 months post-MOF. The analyses included 4126 adults aged ≥50 years with an MOF (1657 hip, 1354 distal forearm, 681 vertebrae, 434 humerus) participating in the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS), a multinational observational study (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain, United Kingdom, and United States). HRQoL at prefracture and 12 months postfracture was measured using the EuroQoL questionnaire (EQ-5D-3L). Health service use data were collected via participant interviews and medical record reviews including in-hospital care; outpatient care; community services; and medication use. Data analyses involved two stages: (i) latent class analyses to identify different combinations of health service use ("classes"); and (ii) logistic regression to assess effects of classes on HRQoL recovery. Analyses were repeated excluding hip fractures (non-hip MOFs). Overall, 2057 MOF participants (49.9%) recovered to their prefracture HRQoL at 12-month follow-up; this proportion was higher for non-hip MOFs (n = 1439; 58.3%). Several distinct classes were identified across countries (range, 2-5 classes). Classes that were associated with increased odds of HRQoL recovery were characterized by a combination of hospital presentations without admission; outpatient department visits; allied health visits; vitamin D/calcium supplementation; and/or non-opioid analgesic use. Similar classes were observed for non-hip MOFs. Understanding country-specific healthcare service pathways that influence greater recovery of HRQoL, particularly services that are uncommon in some countries and routine in others, could improve postfracture care on a global scale. © 2020 American Society for Bone and Mineral Research (ASBMR).

Health service use pathways associated with recovery of quality of life at 12-months for individual fracture sites: Analyses of the International Costs and Utilities Related to Osteoporotic fractures Study (ICUROS).

PURPOSE: We aimed to identify combinations of health service use specific to each major osteoporotic fracture (MOF) site - hip, distal forearm, vertebrae and humerus - associated with recovery of health-related quality of life (HRQoL) 12-months post-MOF. METHODS: Patients were 4126 adults aged ≥50 years with a MOF (1657 hip, 1354 distal forearm, 681 vertebral, 434 humerus) from the International Costs and Utilities Related to Osteoporotic fractures Study (Australia, Austria, Estonia, France, Italy, Lithuania, Mexico, Russia, Spain and the UK). HRQoL (pre-fracture and 12-months post-fracture) was measured using the EQ-5D-3L. Health service use data were collected via interviews and medical record reviews and included in-hospital care, outpatient care, supported living, community health services, and medication use. Latent class analyses were undertaken to identify different combinations of health service use ("classes"); and logistic regression to assess associations between classes and HRQoL recovery. Fracture site-specific analyses were performed using pooled data from all 10 countries. RESULTS: The proportion of patients who recovered to their pre-fracture HRQoL at 12-month follow-up varied across fracture sites: 37.3%, 65.8%, 48.9% and 49.5% for hip, distal forearm, vertebrae, and humerus, respectively. We observed several site-specific classes associated with improved odds of HRQoL recovery. Generally, the combination of hospital presentations without admission; primary care center visits; use of osteoporosis-related medications; vitamin D/calcium supplementation; and non-opioid analgesic use was associated with greater likelihood of HRQoL recovery. CONCLUSION: The identified fracture site-specific health service use pathways associated with recovery of HRQoL could potentially improve the management and health outcomes of patients treated for a MOF.

PERSPECTIVES: Recovery Oriented Services for Persons with Severe Mental Illness Can Focus on Meeting Needs Through Care Coordination.

BACKGROUND: The approach to care for persons with an acute illness is different from that for a person with a chronic disease. Whilst the goal of treatment for an acute illness is to cure the disease, a chronic condition has no cure as such, and hence management requires a team approach that is aimed at achieving goals that are jointly set by service users and providers. Severe and persistent mental illness (SPMI) is a chronic disease. However, in many mental health services, the approach to care for persons with SPMI is similar to those who have an acute mental illness. AIM: The aims of this paper are twofold: (i) to make an argument for recovery oriented services to focus on meeting clients' needs rather than on symptom reduction, (ii) to propose a model of service provision where clinical mental health services form a part rather than the mainstay of care for people with SPMI. RESULTS: Using examples from Australia's Partner's in Recovery initiative and other recovery literature, we start by describing how SPMI should be treated as a chronic disease that focuses on recovery. We then highlight how mental health services continue to monitor outcomes based on clinical rather than personal recovery. Next, we diagrammatically illustrate how needs can be aligned with the recovery process and illustrate how care coordination can be the hub of service delivery in a hub and spoke model. We conclude with comments on workforce requirements and costs of a needs-based recovery oriented service. DISCUSSION: In a needs based model, the role of the specialist mental health service will move from being at the centre of care to being one of the components of care and the role of the care coordinator will become central. Although, there are as yet no randomised controlled trials to show that meeting needs of persons with SPMI will significantly contribute to their recovery, preliminary studies show that it is possible. IMPLICATIONS FOR HEALTHCARE PROVISION AND USE: The role of the care coordinator becomes the hub of service provision collaborating with agencies such as family practices, specialist mental health services, legal, housing, employment, education, and community services. IMPLICATIONS FOR HEALTH POLICIES: A shift from the current model of care to a needs based approach requires a revolutionary change in the way we do business and will have to be the largest shake up of the mental health service system since deinstitutionalisation. IMPLICATIONS FOR FURTHER RESEARCH: It is a long journey from the status quo to a needs based approach. The first step would be to gather more evidence on the usefulness of addressing people's needs in achieving recovery.

Validation of de-identified record linkage to ascertain hospital admissions in a cohort study.

BACKGROUND: Cohort studies can provide valuable evidence of cause and effect relationships but are subject to loss of participants over time, limiting the validity of findings. Computerised record linkage offers a passive and ongoing method of obtaining health outcomes from existing routinely collected data sources. However, the quality of record linkage is reliant upon the availability and accuracy of common identifying variables. We sought to develop and validate a method for linking a cohort study to a state-wide hospital admissions dataset with limited availability of unique identifying variables. METHODS: A sample of 2000 participants from a cohort study (n = 41 514) was linked to a state-wide hospitalisations dataset in Victoria, Australia using the national health insurance (Medicare) number and demographic data as identifying variables. Availability of the health insurance number was limited in both datasets; therefore linkage was undertaken both with and without use of this number and agreement tested between both algorithms. Sensitivity was calculated for a sub-sample of 101 participants with a hospital admission confirmed by medical record review. RESULTS: Of the 2000 study participants, 85% were found to have a record in the hospitalisations dataset when the national health insurance number and sex were used as linkage variables and 92% when demographic details only were used. When agreement between the two methods was tested the disagreement fraction was 9%, mainly due to "false positive" links when demographic details only were used. A final algorithm that used multiple combinations of identifying variables resulted in a match proportion of 87%. Sensitivity of this final linkage was 95%. CONCLUSIONS: High quality record linkage of cohort data with a hospitalisations dataset that has limited identifiers can be achieved using combinations of a national health insurance number and demographic data as identifying variables.