FLS: Annual Reporting Survey (mini survey) Step 1 of 5 20% Section 1: Information about your FLSWithin OC’s FLS Registry and for the purposes of this audit, FLSs are assessed by individual hospital sites. For hospital corporations which may operate an FLS at two or more separate sites, a separate submission form must be filled out for each individual FLS site. For any questions in filling out this questionnaire, please contact Luanne Schenkels at lschenkels@osteoporosis.caFLS site informationPerson submitting this form: First name Last name Email of submitter 1. Name of your hospital/site, exactly as it should appear on the OC FLS Registry:City, Province Section 2: Staff working for your FLSa. Dedicated FLS coordinator’s name: First Last Is there more than one FLS Coordinator working at your site? No Yes, there are additional FLS Coordinators working at our site. Please provide details in the comments section. Comments (name of additional FLS Coordinators):b. FLS Medical Lead's name: First Last Medical lead's specialty or background (e.g. osteoporosis specialist, orthopaedic surgeon, care of the elderly physician, family physician, other): Section 3: Type of FLS3. Type of FLS: (Click only one answer) a. Hip-only FLS falling under the “no dedicated FLS coordinator” exception rule. All of the hospital’s admitted fragility hip fracture patients are automatically referred to an osteoporosis specialist. b. Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the orthopaedic inpatient ward). Our FLS enrolls only hip fracture patients. c. Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the inpatient ward). Our FLS enrolls more than just hip fracture patients. d. Outpatient-only FLS (i.e. the FLS coordinator first meets the patient directly in the orthopaedic outpatient clinics). e. Combined inpatient/outpatient FLS (i.e. the FLS coordinator does systematic and pro-active case finding both on the orthopaedic inpatient ward AND in the orthopaedic outpatient clinics. Some patients, e.g. hip fracture patients, are first seen in person while still on the orthopaedic ward and others, e.g. wrist fracture patients, are first seen in person during their visit to the orthopaedic outpatient clinic). f. Other. Briefly describe your model, including how the systematic and pro-active case finding occurs.When/where does the osteoporosis specialist see the majority (> 50%) of the hip fracture patients? a. Patient is seen by the osteoporosis specialist while the patient is still hospitalized on the inpatient orthopaedic ward. b. Patient is given an appointment to see the osteoporosis specialist post-discharge on the same day and location as his/her appointment at the orthopaedic outpatient clinic. c. Patient is given an appointment to see the osteoporosis specialist post-discharge on the same day and location as his/her appointment for BMD testing. d. Patient is given an appointment to see the osteoporosis specialist post-discharge, unrelated to either of the appointments at the orthopaedic clinic or the BMD testing. Please provide any other relevant details e. Other. Please specify: Please provide any other relevant details:Other, please specify:Annual number of hip fractures (12 consecutive months, must be from within the last 3 years) admitted to or discharged from your hospital as per your hospital’s administrative database (must be a database independent from your own FLS’s database):Time frame of (Annual number of hip fractures):If you have clicked on 'f" above, before going any further with this questionnaire......please provide a brief overview of your program to Luanne Schenkels at Lschenkels@osteoporosis.ca and you will be contacted promptly with guidance for your specific program. Section 4: Annual reporting4. Annual FLS enrollment reporting:a. How many fragility fracture patients (aged 50 and up) were newly enrolled in your FLS between April 1, 2018 and March 31, 2019?b. i) Of the patients in "a" (above), how many were hip (proximal femur) fractures?b. ii) Of the patients in "a" (above), how many were wrist (distal radius) fractures?b. iii) Of the patients in "a" (above), how many were shoulder (proximal humerus) fractures?b. iv) Of the patients in "a" (above), how many were pelvic fractures?b. v) Of the patients in "a" (above), how many were spine/vertebral fractures?b. vi) Of the patients in "a" (above), how many were other fracture types?For b. vi), please list other fracture types (if applicable):For b. vi), please list other fracture types (if applicable): Section 5: PermissionThank you for your collaboration.*Osteoporosis Canada may use aggregate data from this audit for possible publication and/or research purposes. The individual FLS sites would remain completely anonymous in the event of any publication. I consent to the use of the data collected in this questionnaire for the purpose stated above. I do not consent to the use of the data collected in this questionnaire for the purpose stated above. FLS: Annual Reporting Survey (mini survey) Step 1 of 5 20% Section 1: Information about your FLSWithin OC’s FLS Registry and for the purposes of this audit, FLSs are assessed by individual hospital sites. For hospital corporations which may operate an FLS at two or more separate sites, a separate submission form must be filled out for each individual FLS site. For any questions in filling out this questionnaire, please contact Luanne Schenkels at lschenkels@osteoporosis.caFLS site informationPerson submitting this form: First name Last name Email of submitter 1. Name of your hospital/site, exactly as it should appear on the OC FLS Registry:City, Province Section 2: Staff working for your FLSa. Dedicated FLS coordinator’s name: First Last Is there more than one FLS Coordinator working at your site? No Yes, there are additional FLS Coordinators working at our site. Please provide details in the comments section. Comments (name of additional FLS Coordinators):b. FLS Medical Lead's name: First Last Medical lead's specialty or background (e.g. osteoporosis specialist, orthopaedic surgeon, care of the elderly physician, family physician, other): Section 3: Type of FLS3. Type of FLS: (Click only one answer) a. Hip-only FLS falling under the “no dedicated FLS coordinator” exception rule. All of the hospital’s admitted fragility hip fracture patients are automatically referred to an osteoporosis specialist. b. Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the orthopaedic inpatient ward). Our FLS enrolls only hip fracture patients. c. Inpatient-only FLS (i.e. the FLS coordinator first meets the patient directly on the inpatient ward). Our FLS enrolls more than just hip fracture patients. d. Outpatient-only FLS (i.e. the FLS coordinator first meets the patient directly in the orthopaedic outpatient clinics). e. Combined inpatient/outpatient FLS (i.e. the FLS coordinator does systematic and pro-active case finding both on the orthopaedic inpatient ward AND in the orthopaedic outpatient clinics. Some patients, e.g. hip fracture patients, are first seen in person while still on the orthopaedic ward and others, e.g. wrist fracture patients, are first seen in person during their visit to the orthopaedic outpatient clinic). f. Other. Briefly describe your model, including how the systematic and pro-active case finding occurs.When/where does the osteoporosis specialist see the majority (> 50%) of the hip fracture patients? a. Patient is seen by the osteoporosis specialist while the patient is still hospitalized on the inpatient orthopaedic ward. b. Patient is given an appointment to see the osteoporosis specialist post-discharge on the same day and location as his/her appointment at the orthopaedic outpatient clinic. c. Patient is given an appointment to see the osteoporosis specialist post-discharge on the same day and location as his/her appointment for BMD testing. d. Patient is given an appointment to see the osteoporosis specialist post-discharge, unrelated to either of the appointments at the orthopaedic clinic or the BMD testing. Please provide any other relevant details e. Other. Please specify: Please provide any other relevant details:Other, please specify:Annual number of hip fractures (12 consecutive months, must be from within the last 3 years) admitted to or discharged from your hospital as per your hospital’s administrative database (must be a database independent from your own FLS’s database):Time frame of (Annual number of hip fractures):If you have clicked on 'f" above, before going any further with this questionnaire......please provide a brief overview of your program to Luanne Schenkels at Lschenkels@osteoporosis.ca and you will be contacted promptly with guidance for your specific program. Section 4: Annual reporting4. Annual FLS enrollment reporting:a. How many fragility fracture patients (aged 50 and up) were newly enrolled in your FLS between April 1, 2018 and March 31, 2019?b. i) Of the patients in "a" (above), how many were hip (proximal femur) fractures?b. ii) Of the patients in "a" (above), how many were wrist (distal radius) fractures?b. iii) Of the patients in "a" (above), how many were shoulder (proximal humerus) fractures?b. iv) Of the patients in "a" (above), how many were pelvic fractures?b. v) Of the patients in "a" (above), how many were spine/vertebral fractures?b. vi) Of the patients in "a" (above), how many were other fracture types?For b. vi), please list other fracture types (if applicable):For b. vi), please list other fracture types (if applicable): Section 5: PermissionThank you for your collaboration.*Osteoporosis Canada may use aggregate data from this audit for possible publication and/or research purposes. The individual FLS sites would remain completely anonymous in the event of any publication. I consent to the use of the data collected in this questionnaire for the purpose stated above. I do not consent to the use of the data collected in this questionnaire for the purpose stated above.
