United NationsDepartment of Economic and Social Affairs Sustainable Development

Geriatric Fracture Program Done in 48 hours - Johnson & Johnson Medical Devices team succeeded to change the trajectory of healthcare for elderly people in Russia

    Description
    Intro

    230,000 of geriatric patients suffer from hip fractures in Russia annually. It is more than the most common diseases among this social group–heart attacks, thoracic cancer, colorectal cancer. Up to 61% of them are non-hospitalized and 23% gets conservative treatment, while the international gold standard is surgery within 48 hours. About 110,000 people die every year from the fracture consequences. The treatment standards need improvement to reach the worldwide gold standard – surgery within 24-48 hours from the fracture to save up to 60,000 lives each year. The practice will change the trajectory of healthcare for elderly people in Russia – now and in the future.

    Description

    Due to the nature of this mortality – patient is immobilized and dies from thrombosis, pneumonia or cardiovascular diseases – the official statistics do not indicate the cause of mortality as hip fracture. This makes the problem paradoxically invisible for the government and healthcare system. There are few reasons for such high mortality rate: not sophisticated patient pathway principles; lack of the official statistics to recognize the burden; stigma that exists in Russian society with huge fear of surgery among seniors and their families; not enough tariffs to cover the surgery; high share of conservative treatment; clinical guidelines are not synchronized between different medical specialties so there are no strict rules who should treat the patient and no responsibility for the outcome. All these pain points needed to be fixed in total.

    Contribution to SDG Implementation

    SDG #3 aims to promote healthy lives for all at all ages. For seniors in Russia it means access to the most advanced modern technologies reimbursed by the government in case of hip fracture. One in four Russian citizens is already at retirement age and by 2035 their share will be 30% or 43,3 millions of people. The practice can be scaled to other countries experiencing the same system problems. This practice benefits also to SDG #10, especially during and after COVID-19 when the most vulnerable groups including older persons are being hit hardest.

    Implementation methodologies

    In 2019 J&J Russia team initiated the Geriatric Fracture Program designed to change approach of hip fracture treatment on the federal level, including obligatory surgical treatment, patient pathway management, public investment, governmental KPIs. The team initiated an epidemiological and health economics research with state agency to cover the gaps in official statistic. The research showed real incidence and mortality, healthcare system issues and hip fracture burden. Team developed and executed lobby strategy for providing solutions to different levels of state stakeholders – partnering and working with Chief Geriatric Officer, chief traumatologists, social foundations and Ministry of Health. More than 20 federal events with customized content on the top level forums and conferences were organized. An important step was to break the stigma and fighting with agism in society by building awareness. The project was accompanied by massive PR campaign featuring #OldLivesMatter movement – in total more than 500 different publications, TV and social media posts were generated with potential outreach of more than 990 mln of contacts. In 2020 COVID Pandemic locked senior people at home and increased domestic fracture risk, so PR campaign for fall prevention actualization was developed to distribute infographics and useful tips for senior through the media and social advertising videos. In 2019 Johnson & Johnson Russia together with the charity foundation and under governmental support have launched Nordic Walking team competition among inhabitants of eleven retirement houses in six different Russian regions. The aim of the competition was to build awareness of the problem of hip fracture and its prevention among patient audience and to get support from the media side.

    Results

    As a result of all these activities and efforts the problem of non-surgical treated fractures was delivered to the state officials. Clinical Guidelines were revised in December 2020 and obligatory surgical treatment within 48 hours after the fracture is now included into it. Moreover, statistic form was updated and number of patients hospitalized within 24 hours after hip fracture was included as a hospitals’ KPI. The most important that the Geriatric Fracture State Program was signed by the Federal Government with specific KPI and implementation plan including pilot regions. The program was integrated in the President Putin’s National Project. The program is supposed to save up to 60,000 lives each year. The number of hip fracture procedures will be increased by 6 times by 2030. This project will change the trajectory of healthcare for elderly people in Russia. The quality of medical care will be improved for all patients who are treated in traumatology departments.

    Factors and Constraints

    One of the main enabling factors has become partnership between different stakeholders as well as extensive international and local expertise brought by J&J team. Different parts of the system were in place, but in total it did not work properly. The project team served as mediator to finetune the process and bring it up to the worldwide standards. Financial resources were limited as well as physical abilities for the meetings during the COVID-19, so in 2020 major parts were done through the publicity, online top level conferences and close partnership with Chief Geriatric Officer and her office.

    Sustainability and replicability

    Geriatric Fracture State Program was signed by the Federal Government with specific KPI and implementation plan including pilot regions. The program was integrated in the President Putin’s National Project. The KPIs for the first year includes 7 pilot regions, with federal coverage up to 85 regions till 2024. With the growing importance of the optimization imperative and value-based healthcare in different countries this practice could become an ease for this burden. Finally the investments for the proper and in-time surgical treatment of hip fractures turn into saving on the long-term period. The population is more healthy, long-living, active which means that economic is stable and growing.

    COVID-19 Impact

    In 2020 COVID Pandemic locked senior people at home and increased domestic fracture risk. The project team initiated information campaign for fall prevention actualization – distribution of infographics and useful tips for seniors through the media and social advertising videos. The access to the qualitative medical care for older people during COVID was limited, so it became even more important to deliver the agenda to the state’s and clinical stakeholders. Unfortunately due to the lockdown the project team was not able to organize another wave of Steps to Longevity Nordic Walking competition for retirement houses which was planned for more regions and teams. It was replaced with the donation for PPE to the older people there. The competition might become regular in new normal times.

    Contact Name
    Maria
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    Organization/entity
    Johnson & Johnson LLC
    SDGs
    Geographical coverage
    Timeline
    08 April 2019 (start date)
    31 December 2020 (date of completion)
    More information
    Countries
    Russian Federation
    Russian Federation
    Partnership
    N/A
    Contact Information

    Maria, Geriatric Fracture Program Done in 28 hours