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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:


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


  1. 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


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


  1. Establish a system of incentives and/or sanctions. High quality care is linked to higher remuneration
  2. Iterate the process until the goal is achieved
  3. 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.

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

Read more at:

Agency for Healthcare Research and Quality Service Delivery Innovation Profile for Kaiser Permanente Healthy Bones Program.

Ten Strategies To Lower Costs, Improve Quality, And Engage Patients: The View From Leading Health System CEOs. Cosgrove DM, Fisher M, Gabow P, Gottlieb G, Halvorson GC, James BC, Kaplan GS, Perlin JB, Petzel R, Steele GD, Toussaint JS. Health Aff (Millwood). 2013 Feb;32(2):321-327. PubMed ID 23381525

Fracture prevention in Kaiser Permanente Southern California. Dell R. Osteoporos Int. 2011 Aug;22 Suppl 3:457-460. PubMed 21847765