The Value of Fracture Liaison Services: A Focus Group Study

Friday, 28 July 2017: 11:05 AM

Sharon Kan-Ha Chow, DNP(c)
Care Management, Kaiser Permanente, Pomona, CA, USA


Economic analysts have predicted that worldwide aged 65 years and older will increase to more than 1.3 billion by 2040. The growing aging population carries a high prevalence of osteoporosis and a high incidence of morbidity and mortality. In the United States, only 5% of patients with osteoporosis are properly diagnosed. The International Osteoporosis Foundation advocates Fracture Liaison Services (FLS) as best practice that ensures appropriate osteoporosis testing, diagnosis, treatment and ongoing support for fracture patients. Highly collaborative Kaiser Permanente Southern California Healthy Bones Program is recognized as best FLS practice to proactively identify, screen, and treat adults who may have or be at risk for osteoporosis. The purpose of this qualitative study is to explore the value of the Healthy Bones Program as perceived by Kaiser Permanente members aged 65 years and older, specifically relating to patient care experiences and health outcomes. A secondary purpose is to elicit information about members’ knowledge and value for the collaborative efforts that are implemented to improve patient care experiences and health outcomes.


Two focus group interviews were conducted with 6 participants per group, for a total of 12 participants at Fontana Kaiser Permanente Medical Center. The interviews were conducted by the primary investigator and co-investigator using semi-structured, open-ended and prompting questions to gain participants’ detailed insights. All recorded interviews were professionally transcribed verbatim. Qualitative content analysis and interpretive processes were utilized to facilitate better understanding of participants’ experiences and perceptions. The use of Nvivo software assisted in coding, as well as generating reports of coded text for analysis. A word cloud was developed to enhance a visual representation of overlapping themes within the study.


This focus group study successfully explored participants’ understanding and experience of the value of Healthy Bones Program, and investigated participants’ views on how they would like to be involved in care experiences and health improvement. Five cluster themes and their subthemes were identified, such as Healthy Bones Program knowledge, perceived collaborative care, osteoporosis self-care management, Healthy Bones Program care experiences, and healthy lifestyle and living longer. Participants’ positive and negative comments of their care experiences were carefully summarized. Health education of bone health and osteoporosis management were highly appreciated as beneficial and informative intervention, to enrich and empower osteoporosis self-care management. Participants felt well informed and motivated, to get more involved in their osteoporosis care. Participants experienced that electronic health records facilitated collaborative care in osteoporosis screening, treatment and follow up. Preventive care was valued as the key measure for general health and bone health promotion. Participants commented that bone health promotion and osteoporosis prevention should be started at an earlier age, around 30-40 years of age. In order to live longer, participants all seek for health education, and maintain healthy eating and healthy lifestyle.


In today’s ever-changing, complex healthcare systems, patient care experience is purposefully built on an organization’s collaborative efforts to shape a positive care experience. When patients can have a voice, quality patient-centered care will be expected throughout health continuum. In order to meet the preventive care commitment, FLS strategies will interprofessionally help decrease the burden of osteoporosis. The focus group study findings can influentially impact in measuring program success, and triggering necessary program improvement. The results will be disseminated at the local, national and international levels to transform collaborative, evidence-based osteoporosis care management, to improve patient care experiences and health outcomes.