United States of America

Kaiser Permanente Healthy Bones Program

Over the last 15 years, the Kaiser Permanente Healthy Bones Program has grown to become one of the most successful fracture prevention initiatives in the world. In 2007, it was estimated that the program prevented 970 hip fractures among the 3.2 million members of Kaiser Permanente in Southern California. Since launching in 1998, the Healthy Bones Program has led to an overall 38% reduction in the expected hip fracture rate.

At the outset, the Healthy Bones Program aimed to reduce the incidence of hip fractures by 25%. The Plan-Do-Study-Act rapid cycle process improvement methodology was employed to drive continuous quality improvement:

Plan

Build a team led by a champion
Set a goal
Identify patients at risk for a hip fracture
Risk stratify the population – build the ‘work list’

Ensure that work is done by the right person at the right time. When a care gap is found, someone must close that care gap. Care managers ‘work the list’ at Kaiser Permanente

Study

Measure the work done
Look for variation and make improvements by adapting/adopting good ideas from elsewhere

Act

Establish a system of incentives and/or sanctions. High quality care is linked to higher remuneration
Iterate the process until the goal is achieved
Establish higher goals when initial goals have been achieved

All 13 Kaiser centres in Southern California achieved Gold status from the International Osteoporosis Foundation’s Capture the Fracture Campaign.

The Kaiser team are also the current Guinness World Record holders for the number of DXA scans done in one day at multiple venues!