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International Journal of EndocrinologyVolume 2010 2010, Article ID 590751, 7 pages

Research ArticleDepartments of Orthopedic Surgery and Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA

Received 14 April 2009; Accepted 5 July 2009

Academic Editor: Diane Kamen

Copyright © 2010 Julie Glowacki et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We designed, implemented, and revised the Brigham Fracture Intervention Team B-FIT initiatives to improve in-hospital care of fracture Fx patients. Effectiveness was evaluated for 181medical records of 4 cohorts in four successive years of consecutive patients who were admittedwith a fragility hip Fx. The Discharge Initiative DI computer-based includes 1200 mg calcium and1000 IU vitamin daily. The Admission Initiative AI was introduced one year later withreminders for serum 25OHD measurement, initiation of daily calcium 1200 mg and vitamin D 800 IU, and an order for Endocrinology consultation, with an amendment for a computer-assistedreminder and a dose of 50 000 IU. Initially, the computer-based DI was more effective 67%than the surgeon-driven AI 33%, . After introduction of a computer-assisted reminder, AIeffectiveness increased to 68%. The marked prevalence of vitamin D insufficiency reaffirms theimportance of incorporating vitamin D recommendations in Fx care pathways.

Author: Julie Glowacki, Mitchel B. Harris, Josef Simon, John Wright, Nikheel S. Kolatkar, Thomas S. Thornhill, and Meryl S. LeBoff



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