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Beyond the Cast: Reimagining Osteoporotic Fracture Care

Empower patients to take charge of their fracture journey to reach optimal physical & emotional recovery & reduce risk of future fractures.

Photo of Patricia Salber

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What challenges or opportunities are you trying to address within the problem? (200 characters or less)

Fragility fracture care is often fragmented & incomplete. The bone gets fixed but osteoporosis isn't diagnosed, contributing fractures (balance) aren't identified, and emotional sequelae are ignored.

Fragility fractures can be devastating events in the life of a patient with osteoporosis. She didn't just break a bone, she suffered a significant emotional trauma - one that's often described like this:

  • "I am terrified of falling again" 
  • "I suddenly feel old and fragile" 
  • "I am afraid I will not get my old life back" 
  • "I keep reliving the fall and I can't sleep"


These symptoms are very similar to the ones described in PTSD

Too often, however, the healthcare system fixes her bone but fails to uncover why she fell or what can be done to prevent it from happening again. And the emotional sequelae that are engulfing her are almost always ignored.

It is also important to note that osteoporosis patients become much more expensive to a health plan/system once they have a fracture because of ER visits, ortho appts, PT, imaging studies. If the next fall is major, such as a hip fracture the costs go up exponentially because of surgical costs, nursing home/rehab stays, durable medical equipment (wheelchairs) and home care. Just like with other chronic illnesses that are currently aggressively managed in organized systems of care because it pays off to do so, these systems will also reap savings from preventing the next fall and fracture.

The Beyond the Cast (BTC) program is a comprehensive approach to osteoporotic fracture care that is based on principles of Population Health Management, an approach commonly used in organized systems of care. Much like the successful digital health management program, Omada Health, BTC involves the use of technology, human coaches, peer support, and data collection to ensure that what needs to be done, gets done. 

Here's how it works:

The patient is enrolled in the BTC program at the time of discharge from the ER or hospital.  Notification is also sent to the system's designated Bone Health Champion to help arrange follow-up. The patient is helped to download the BTC app and instructed on its use. 

The app is a comprehensive support tool that empowers the patient to take charge of their recovery and initiate changes that can reduce the risk of future falls. 

The BTC comprehensive fragility fracture management app includes

  • Info on home care (e.g., can you shower?) and safety (e.g., proper use of crutches) while immobilized
  • Info on physical therapy with links supporting a home PT program
  • Info about osteoporosis screening and treatment modalities with links on how to get screened
  • A tool to assess whether any contributing factors to the fall are present (e.g., balance or vision issues, orthostatic hypotension, neuropathy, poor shoes, home factors) with links for how to get evaluated and how to correct issues (e.g., Tai Chi for balance, grab rails in shower, secure loose rugs, etc.)
  • A detailed explanation plus screening tool to asses for PTSD-like symptoms common after falls/fractures (fear of falling, reliving the event, insomnia, anxiety, guilt) with links for support with symptom management
  • Links to connect with post-fracture care team including the Bone Health Champion
  • Symptom trackers that can easily be shared with providers or used as prompts during clinic visits
  • Links to peer group sites for people with osteoporosis fractures (e.g., American Bone Health)


The Bone Health Champion can be a case manager or other individual who is dedicated to managing the program. The program can be embedded into the health system's existing population health department. 

The Bone Health Champion manages the system's fragility fracture registry, provides outreach to patients with fractures but no evidence of screening for osteoporosis, facilitates follow-up, performs program QA, oversees app updates, and a variety of other program management tasks. One Champion could manage all of the cases in a moderate-sized organized system of care.

Who is your target end user and why will they be interested? (650 characters or less)

End users are older women and men who have suffered a first fragility fracture (low impact fracture in the setting of osteoporosis). These injuries are common; 1/2 of women and 1/4 of men over age 50 will experience one. Although almost everyone will receive care for their fracture (surgery, immobilization), not everyone will get screened for their underlying bone disease (osteoporosis). Even fewer will be assessed for factors that may have contributed to their injury (often a fall). Examples of such factors include balance problems, visual disturbances, neuropathies, other co-morbidities like diabetes or heart failure, and unsafe conditions in the home. And, unfortunately, almost no one gets assessed for debilitating emotional sequelae of the injury, such as insomnia, fear of falling, reliving the event, anxiety, and social isolation all of which may contribute to future fractures. See uploaded patient journeys and stakeholder descriptions to learn more

How is your idea scaleable? (650 characters or less)

The solution is a population health management (PHM) approach to identification and treatment of patients with fragility fractures. The principles are the same as those commonly used to manage chronic conditions such as diabetes. This solution would be best implemented in an organized system of care (OSC) such as a health plan, hospital, ACO, that already has a PHM program that includes: 1. capability to develop the fragility fracture registry 2. Designated bone health champion (could come from existing staff) 3. Patient-facing application (in development) 4. Physician protocol that can be integrated into the EHR (optional) My solution is scalable because almost all OSCs already have PHM programs that have at least the first two components. They have already scaled the processes. They would have to designate a Bone Health Champion and customize the app. Cost of build-out & maintenance should be covered from savings related to fewer fractures as a result of using the program.

What do/will you measure to know if your solution worked? (500 characters or less)

Short term: information from questionnaires/symptom trackers incorporated into the app will be used to see if the intervention reduced symptoms and documented improved functionality in four key realms of care: 1. Fracture recovery (improved range of motion, physical function self-reported via app) 2. Osteoporosis management (DEXA screening, referral for meds, non-med mgmt self-reported via app with confirmation via claims). 3. Evaluation and management of contributing factors (the app can eventually incorporate some eval tools) self-reports via apps questionnaire/symptom tracker. 4. Evaluation and management of emotional sequelae (initially off-the-shelf screening tools such as Primary Care PTSD Screen for DSM-5 can be used to track symptoms via the app. Long term: follow patients claims data over time to see if there are any recurrent falls or fractures. Eventually, a study with a usual care control group should be performed that includes costs so ROI can be calculated

What is the current stage of development of your idea?

  • Prototype: We have done some small tests or experiments with prospective users to continue developing the idea.

If you were to become a Top Idea, would you want to actively participate in piloting your idea?

  • I want my idea piloted, and I prefer to do my own piloting in collaboration with the health system and with assistance from the Challenge partner

Company / Organization Name, if applicable (140 characters or less)

Health Tech Hatch

Website (if applicable)

thedoctorweighsin.com

Tell us about yourself or your team (500 characters or less)

I am a UCSF endocrinology-trained former Kaiser Permanente emergency physician & health plan executive. Currently, I am a run the popular health news site, The Doctor Weighs In (http://bit.ly/2bmTsGy). I also am a contract consultant for CMS & a large Washington-based consulting group. I serve as an advisor to a number of health-tech startups and was recently appointed to the Board of MedShare. The members of my team include: -Kathryn Johnson (https://www.linkedin.com/in/kathryn-johnson-a833304/) -Meg Crofton (https://www.linkedin.com/in/megcrofton/) Meg suffered a fall/fracture and had significant PTSD-like symptoms afterward. - Francesca Nicosia (https://www.linkedin.com/in/francescanicosia/) -Ishita Jain (https://www.linkedin.com/in/ishita-jain-18278aa2/) - Leslie Rose (https://www.linkedin.com/in/leslie-rose-a04323a/) -Ann Bentley (https://www.linkedin.com/in/ann-bentley-42726a24/) Ann has untreated osteoporosis

Location (50 characters)

Larkspur, California, USA

What is your legal / organizational structure?

  • We are a For-Profit Startup or Startup Social Enterprise

Innovator/Organizational Characteristics

  • Female-led organization

How did you hear about the Challenge?

  • OpenIDEO announcement email

Why are you participating in this Challenge?

As I noted in my blog post, What Happened When I Broke My Shoulder (http://bit.ly/2apogKF), a fall is so much more than "just a fall." It is a life-changing event that can lead to decreased activity, social isolation, depression, & grief over the loss of a previously healthy, active life. My personal experience with my first fragility fracture (detailed in the essay) made it clear to me that treatment has to be so much more than just fixing the bone. That was my motivation to join the Challenge.

How does your idea help more people who have had a first fracture either 1) discover they have osteoporosis or 2) access/navigate care?

A systematic population health mgmt (PHM) approach triggered by the initial fragility fracture can ensure that everyone is offered screening for osteoporosis (e.g., DEXA scan). It can also be used to determine if patients actually got their screens. The program includes a designated Bone Health Champion (case manager) who can answer questions & help connect patients to their providers. The solution combines PHM with a patient-facing app that not only has information about the fracture, physical therapy, principles of medication and non-medication management, but also screening tools to evaluate whether there were contributing factors to the fall & whether or not emotional sequelae have occurred. Questionnaires and symptom trackers are incorporated to track progress and evaluate the effectiveness of the intervention. Multiple links will help people access a variety of high-quality resources that can help them return to optimal function. All info can be customized for the OSC.

How is your idea new in the world or how does it build on existing interventions?

My idea builds on the well-established principles of population health programs that are already being used by most organized systems of care (health plans, health systems, ACOs). This being said, most of these programs target high-cost, high prevalence chronic conditions such as heart failure and diabetes - not osteoporosis. The addition of an app that can be used for both patient education/support as well as to evaluate the effectiveness of the interventions would be a novel addition to many of these types of programs. American Bone Health (ABH) has many of the educational elements that are described in the program, however, Beyond the Cast is different because it will be built in the context of an organized system of care in collaboration with physicians and other providers as well as purchasers and insurers of care. A collaboration with ABH would be most beneficial.

Please upload your journey map. Be sure your journey map shows when your user is introduced to the idea and when/how they access it, and illustrates which moments in the Challenge Journey Map your journey map touches.

I have attached two journey maps. One is "without BTC". It traces the patient journey from the fall/fracture to the ER, discharge to home, follow-up in the ortho clinic, and referral to PT. For many fragility fracture patients that, is, unfortunately, the end of the story. The other journey map shows how BTC will positively impact the journey, starting with enrollment in the program at the time of discharge, connection to a Bone Health Champion and the BTC app to guide their journey.

Who did you test your idea with, what did you learn, and how did you evolve your concept?

I tested my idea with a variety of people including seniors, people with osteoporosis, one woman who had fragility fracture complicated by PTSD-like emotional sequelae, a personal trainer who works with people with osteoporosis, a business executive, the former CEO of a population health company, the former CEO of the Health Forum, and others. All of this is summarized in a written document that I uploaded at the beginning of this submission (It is titled "Prototyping Feedback." I also tested the app concept with Kathryn Johnson (the former CEO of the Health Forum), Ishita Jain (prototype coach) as well as Matt Jones and Akhsar Kharebov, serial entrepreneurs with digital health backgrounds. They provided detailed feedback on the concept and app wireframes. The feedback was incorporated into successive versions of the wireframes. I saved the iterations as different versions (labeled v1-v13) in Adobe XD. These are available on request. I also captured how the app functions in the uploaded video titled "Understanding the BTC Program and App." My prototype coach, Ishita Jain, also reviewed the concepts, guided me through the prototype testing. Medical anthropologist, geriatric specialist, and health services researcher Francesca Nicosia gave me feedback on both the concept and how it would fit into an organized system of care, such as the VA.

(Optional) Share documentation of your solution prototyping and testing, such as photos.

My solution prototyping took a number for forms: -In-person iteration at various stages of the idea -Zoom calls to discuss improvements, clarifications -Asynchronous iteration with both the program write-up and other materials (journey maps, the draft app, app videos, etc) I have captured some of the prototyping processes in a document that I uploaded (Prototype Feedback) at the beginning of this submission.

Please upload your Business Model Canvas

The business model canvas was initially drafted based on my personal experience as a Physician Executive at Kaiser Permanente, Chief Medical Officer of a Medicare Advantage health plan, an expert in population health management, and long experience working with employers. I worked with the former CEO of the Health Forum and the former CEO of a population health management program to expand and refine the model.

Please upload your team video.

My team video describes the motivation for joining the challenge and gives you a flavor of the prototyping processes used. I introduce you to my team. And most importantly, I tell fragility fracture stories I heard from many amazing women I met while working on the project. Finally, I reiterate what problem we were trying to solve. I hope you enjoy the video.
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Attachments (2)

App video narrative.docx

This document contains the narrative used in the video.

27 comments

Join the conversation:

Comment
Photo of Susan Jackewicz
Team

Patricia Salber Congratulations on being in the Top Ten ideas for the Healthy Bones Challenge! Helping address patient identity post-fracture via focus on mental health can be so impactful. I hope the Challenge experience continues to inspires you in developing your idea - one much needed by many! Best wishes, Susan

Photo of Patricia Salber
Team

I know our submission deadline is long past, but I want to share a link to what has turned out to be an active forum for women with shoulder fractures so that anyone who has experienced a fracture and ends up here has access to this resource: https://thedoctorweighsin.com/what-happened-when-i-fell-and-fractured-my-shoulder/

The discussion is very interesting demonstrating the need for a peer forum to help people have a better fracture journey.

Photo of Ashley Tillman
Team

Hi Patricia Salber really enjoyed reading about your work! I noticed your first video isn't working, if you send me the link I can fix it for you on the platform.

Photo of Patricia Salber
Team

https://youtu.be/mdYAyOHfYvw
It was working earlier. Wonder what happened. Thanks for fixing it for me.

Photo of Patricia Salber
Team

@Manisha Laroia Hi Manisha, I was able to get the Bix map canvas and the before and after patient journeys to upload. Could you take a look at them and be sure they are readable. Thanks

Photo of Patricia Salber
Team

@Mariah Burton Nelson, @Alan Bryant or @Manisha Laroia
I am starting to upload the documents that I have created but am running into some issues. I created the biz model and the patient journeys using Mural.co (at the suggestion of my prototyping coach. I am able to export those documents at PDFs but it doesn't appear that PDFs can be uploaded. I converted the PDF into a jpg using Photoshop but it won't upload despite multiple attempts (the black wheel just keeps spinning).

I created wireframes for the app that is a key part of my idea using Adobe XD. I have worked with several people to evolve this prototype over time. I saved the results as successive versions of the app in Adobe XD. How can I get these documents to you? Adobe XD allows me to send invites to people for feedback. But there won't be a way to turn this into photos to upload. I will try making a video using XD to show how it works, but the best way to see the app is to use it with the Adobe XD mobile app (works like a charm). Please advise me on how I can best share the app with you.

Finally, I got a ton of feedback in a variety of different ways from a large number of people (this is described in the prototyping section above). Can you take a look and see if the prototyping feedback document I uploaded works for you or if you want something different.

Any other feedback you have for me would be greatly appreciated. I am reconnecting with Ishita Jain, my prototyping coach on Mon or Tues and one of my connections who has been most helpful in prototyping the concept and the app on Wed. I need to pull it all together to complete the submission by 9 am 8/22.

Thanks for any help/guidance you can provide. Pat

Photo of Manisha Laroia
Team

Hi Patricia Salber 
I am sorry I don't have recordings but I can share the decks with you and also put you in touch with the Innovation Coaches in case you wish to get feedback or ask questions.
Will mail the decks right away.

Photo of Patricia Salber
Team

Also, supposed to have a Zoom call with Francesca Nicosia at UCSF at noon. It is now 12:08. I will stay on until 12:15 to see if she is just running late. Otherwise, assuming I should reschedule, right?

Photo of Manisha Laroia
Team

Hi Patricia Salber 
Hope your idea prototyping is on in full swing!
In gratitude and in support of your future work, we would like to invite you to join the final Innovation Coach Office Hours as you continue your innovation learning journey:

Make, Try, Show, Test, Build
Ashutosh Biltharia, Designer and Engineer, MFA, Interaction Design, Umea Institute of Design, Sweden. 10am PST August 5th.

Building Partnerships in Design
Susan Jackewicz, Principal at Takhi Associates, Boston, Massachusetts. 10am PST August 9th.

Love the Problem, Scale the Solution
Chris Cochella, Managing Partner at Sequoia Group, Salt Lake City, Utah. 9 am PST August 12th.

Sign up here to attend
https://forms.gle/jPPAZvUfJ2u8oXuz5

Photo of Patricia Salber
Team

Manisha, can you send me links to the videos of each of these 3 Coach Office Hours meetings so I can review me. Thanks

Yes, prototyping in full swing. Learning a lot.

Photo of Estela Kennen
Team

I haven't done a lit review in this area, but I ran into this today and it felt pertinent. Seems like there's a lot we don't know about the best way to manage post-fall psychosocial health. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007624.pub3/full

Photo of Patricia Salber
Team

Thanks, great reference. There is definitely a need for more high-quality research in this area.

Photo of Susan Jackewicz
Team

Hi Patricia Salber ,
I'm Susan Jackewicz, another Innovation Coach with OpenIDEO. Thank you for focusing on an important aspect of the patient experience - mental health impacts. Your story of what happened after your fracture is compelling. It seems to me the question you're addressing is to help the patient answer: "What just happened to me, and how can/should I deal with it?" Mayo Clinic worked with a design research team a while back that focused on the clinician/patient conversation, which helped both sides articulate the issues and barriers to health within the clinical visit. They identified many issues that were primarily emotional/behavioral health related, and concluded that better health (mental/physical/ability to define/follow a care plan) looked like a better conversation. There is now a series of Toolkits for both patients and clinicians available via a non-profit that helps with articulation of fears, barriers, and issues on both sides of the conversation. You might want to check it out to see if it spurs any ideas for development related to comments Chris Cochella made in another post. https://patientrevolution.org/tools

Photo of Patricia Salber
Team

Thanks for the helpful comment. I will check out the Toolkits. Pat

Photo of Mariah Burton Nelson
Team

Hi Patricia Salber 
Your idea appeals to me too. I appreciate the wholistic, multi-faceted approach. Like others, I encourage you to consider expanding the concept "PTSD-like symptoms" - to include "regular-old" anxiety and depression. Both can lead to decreased physical activity, which itself can paradoxically lead to falls, as people lose fitness and balance and thus become more prone to experience the very thing they're afraid of re-experiencing.

Now for another idea: Your blog conversation is fascinating - and popular! People want to tell you their stories, and to feel heard and supported. They want advice, yes, but they also want understanding from someone who is both a fracture patient (twice! sorry about that wrist!) and an expert. There are many online communities related to health, and their popularity also proves this point. (Inspire is one that I have found very helpful for a few health and caregiver conditions.) (https://www.inspire.com/) Therefore I wonder if you might consider adding an online community invitation or resource to your package of resources for people post-first-fracture. Surely it could help with loneliness as people find themselves in isolating situations due to the need to rest broken bones.

Mariah Burton Nelson
OpenIDEO Innovation Coach and 63-year-old with osteoporosis who broke her toes falling downstairs 3 weeks ago and also wants to tell you her story, but is refraining because it's not really relevant here, but that very urge also supports the thesis that we all want to connect. :-)

Photo of Patricia Salber
Team

Sorry for the slow reply. Thanks for the encouragement and for the link to Inspire. I am a huge fan of peer-support groups. You can share and learn so much about how your condition impacts day-to-day life and get practical suggestions for how to improve.

I hope your toes have healed well. Pat

Photo of Susannah Bailin
Team

Hi Patricia,
I would love to collaborate with you! AdviceCoach can package your content -- PT exercises, educational materials, surveys that capture mental health issues, home health care instructions, etc -- in our app right now. You can add video, photos, audio and diagrams in addition to text to make the journey varied and easily accessible. We are currently working with a distributor of pregnancy/post-partem and fertility content to be offered through OB practices. I look forward to continuing the conversation! Susannah (susannah.bailin@advicecoach.com)

Photo of Estela Kennen
Team

Wow, Patricia. Thank you for sharing your story. Thank you also for focusing on the PTSD-like effects of falls; this certainly feels like an under-addressed area with lots of room for improvement. However, studies suggest that not all fall victims suffer from PTSD, so maybe this could be part of a more comprehensive post-fall package (which you were perhaps implying)? I also wonder how willing insurers would be to cover a prophylactic mental health provider (and whether there are even enough to fill the need in the first place). Maybe everyone could get some sort of baseline treatment -- generic tips and post-fall screening, perhaps -- and those at greatest risk could receive more robust intervention?

Your integrated health care journey sounds so seamless, you already knew you suffered from osteopenia, and you have the ability to access and process very high levels of medical information. The reality for too many people is their bone problems go undetected before AND after fractures, their health care journeys are fragmented, and they have limited health care efficacy. This might be an extremely tall order, but I appreciate your perspective: What can we do to spread programs like Kaiser's, improve screening rates, and increase patient knowledge -- while also integrating psychoemotional health considerations into the post-fracture experience?

I look forward to reading your thoughts and watching your idea evolve!

Photo of Patricia Salber
Team

Hi Estela,

Thank you for your excellent and detailed comment.

I do think addressing PTSD-like symptoms could be integrated into a comprehensive post-fall package - one that also includes a heavy emphasis on home PT to regain full range of motion.

Yes, it would be expensive to do in person mental health counseling, but I think having a comprehensive post-fall app that included links to virtual counseling could be achievable.

Kaiser did do an excellent job of identifying me as an at-risk individual and bringing me in for further evaluation and potential treatment for osteoporosis. They did not, however, address the psycho-emotional aspects of my fracture. I did not bring it up either. That is why I think providing this information to patients and clinicians is so important.

I think the development and dissemination of a comprehensive app is the best way to spread this type of program. I would love to see this IDEO effort result in the identification of a team of clinicians, patients, developers, UX people that could take on this challenge.

Effective osteoporosis interventions have to be much more than meds.

Pat

Photo of Patricia Salber
Team

Hi Estela,

Thank you for your excellent and detailed comment.

I do think addressing PTSD-like symptoms could be integrated into a comprehensive post-fall package - one that also includes a heavy emphasis on home PT to regain full range of motion.

Yes, it would be expensive to do in person mental health counseling, but I think having a comprehensive post-fall app that included links to virtual counseling could be achievable.

Kaiser did do an excellent job of identifying me as an at-risk individual and bringing me in for further evaluation and potential treatment for osteoporosis. They did not, however, address the psycho-emotional aspects of my fracture. I did not bring it up either. That is why I think providing this information to patients and clinicians is so important.

I think the development and dissemination of a comprehensive app is the best way to spread this type of program. I would love to see this IDEO effort result in the identification of a team of clinicians, patients, developers, UX people that could take on this challenge.

Effective osteoporosis interventions have to be much more than meds.

Pat

Photo of Susannah Bailin
Team

Hi @psalber!,I would love to collaborate with you. AdviceCoach can package your program -- PT exercises, educational material, quizzes to determine mental health, home health care instructions -- in our app by condition or surgery or anything else that categorizes and personalizes the patient's experience. You can use video, photos, story, audio to make the journey easily accessible, rather than all in text. I hope we can continue the conversation! susannah.bailin@advicecoach.com

Photo of Manisha Laroia
Team

Hi Patricia Salber 
Thank you for being super-active through the Ideas Phase of the Healthy Bones Challenge.
Excited to see all the conversation around your idea here. Great work!

A reminder to make any last minute tweaks you wish to asap.
The DEADLINE for idea submission is Wednesday July 3rd, 2019 5pm PST.

A CHECKLIST to guide you.
Please make sure your idea does the following:
1) Clearly define the problem
2) Connects to at least one opportunity area
3) States how & when user accesses the solution
4) Tells the story

Let me know if you need anything.
All the best for the next phase of the challenge.

Manisha
OpenIDEO Challenge Team

Photo of Manisha Laroia
Team

Hi Patricia Salber 
Thank you for sharing your idea here.
We have a special Office Hours session coming up to interact with our Innovation Coaches and be part of a QnA.
We would love for you to join in and support you in refining your idea.

TITLE:
A story of two halves. Defining your problem and telling your solutions story. –with Alan Bryant, Senior strategist at Livity
DATE & TIME: Friday 28th June, 2019 10am PST
RSVP:
https://calendly.com/atillman-1/a-story-of-two-halves-defining-your-problem-and-tellin?month=2019-06&date=2019-06-28
DETAILS:
We'll start by workshopping how to clearly define and articulate the problem you are solving, then look at how to get to the root cause and the impact this has on your idea. Before we move on to talk about narrative structures and how to tell your ideas story in the most clear and engaging way for your audience.

Manisha
OpenIDEO Community Fellow

Photo of Estela Kennen
Team

Hi Patricia,

Chris Cochella wrote this on another post, and I thought it might be worth cross-pollinating:"For what is worth, a primary care physician I interviewed a while back cited that disengagement, apathy and loneliness are major factors for all types of compliance (food, medications, activity, etc.). In this physician's opinion the increase in disengagement, apathy and loneliness "might" go up after a first fracture. "

This isn't related to PTSD, but it does speak to the idea that there are wide-spread mental health issues surrounding chronic disease in general, and osteoporosis in specific. Pain, anxiety, fear, the cognitive load of treatment management, loss of self-efficacy and self-regard, the ensuing depression... these are very heady issues that patients (and caregivers) are left to deal with by themselves, which make compliance difficult and recovery and uphill battle (which just serves to perpetuate the cycle of loss and anxiety). I haven't looked into this too deeply, but it seems like an area potentially ripe for intervention if you are interested in looking at mental health issues inclusive of, but not limited to PTSD.

Photo of Chris Cochella
Team

Hi @Patricia Salber 
Thank you for the submission. I am an Innovation Coach at OpenIDEO.Clearly, you have a grasp on the complexities of the healthcare system. There are, indeed, many moving parts.

I appreciate your focus on the PTSD or psychological/emotional state of the patient post first fraction.

You have stated the problem as:

PTSD-LIKE SYMPTOMS (FEAR OF FALLING, RELIVING THE FALL, ANXIETY & INSOMNIA) ARE COMMON IN PATIENTS WITH OSTEOPOROSIS AND A FIRST FRACTURE. THEY MAY INCREASE THE RISK OF FURTHER FALLS AND FRACTURES.

Could you elaborate on what ways the mental health PTSD-like symptoms lead to further falls and fractures? Do you have evidence of this? (literature, studies, etc.)

I do believe that this area you have identified is significant problem and worth developing a solution for. The evidence and a more detailed problem statement would provide valuable validation.

Thank you.
Chris

Photo of Estela Kennen
Team

Following.

Photo of 昕悦 张
Team

Hi Estela,

Thank you for your excellent and detailed comment.
i do think we should pay attention to PTSD, so it should be have a effective osteoporosis interventions such as a mental health provider for the people who are released to home after the fracture has been set or repaired.