Table 2.

Quality of care variables and epidemiological measurements

Source	Description of measure
National Quality Forum (NQF) #0053 [17]	Osteoporosis management in women who had a fracture (primary study objective). Assesses whether women over 67 years of age who had one or more bone fractures received, within 6 months of the fracture, a bone density test to determine if osteoporosis was the underlying cause of the fracture and/or received appropriate prevention/treatment for osteoporosis.
Centers for Medicare and Medicaid Services (CMS) Physician Quality Reporting System (PQRS) Measure #40 [19]	Management following fracture of hip, spine, or distal radius for men and women aged 50 years and older (display measure in FLS App). Percentage of patients aged 50 years and older with fracture of the hip, spine, or distal radius who had a central dual-energy X-ray absorptiometry (DXA) measurement ordered or performed or pharmacologic therapy prescribed.
CMS, PQRS Measure #24 [19]	Communication with the physician managing ongoing care post-fracture of hip, spine, or distal radius for men and women aged 50 years and older (display measure in FLS App). Percentage of patients aged 50 years and older treated for a hip, spine, or distal radial fracture with documentation of communication with the physician managing the patient’s ongoing care that a fracture occurred and that the patient was or should be tested or treated for osteoporosis.
The Joint Commission (Osteoporosis-Associated Fracture) #OAF-01 [18]	Laboratory investigation for secondary causes of fracture (display measure in FLS App). Patients with fragility fracture who have had appropriate laboratory investigation for secondary causes of fracture ordered or performed prior to discharge from inpatient status.
The Joint Commission #OAF-03 [18]	Discharge instructions—Emergency Department (display measure in FLS App). Patients age 50 or over with a fracture of the vertebra, pelvis, wrist, ankle, or humerus discharged from the Emergency Department to home, or their caregivers, who have received written discharge instructions regarding the need to follow up with a primary care physician, hospital outpatient department, or specialist for possible osteoporosis to reduce the risk of future fracture, or who were contacted by a fracture liaison service.
NQF #0037 [17]	Osteoporosis testing in older women (exploratory objective). Examine the rate of primary osteoporosis screening in post-fracture patients by estimating the proportion of post-menopausal women over the age of 65 who had a bone density test for osteoporosis, classify these patients, and evaluate their post-diagnosis outpatient-related treatment patterns.
Bone Health Collaborative	FLS process adherence measure. Measure FLS Coordinator adherence to the tasks and timelines of the standardized FLS process.