2026 Eastern States Conference

Authors: Kyndal Lemelin, PharmD; Jillian Dann, PharmD, BCPS, BPTXP; Kylea Clark, PharmD; Kathlene DeGregory, PharmD, BCOP

Objective: Appreciate the risk of bone mineral density loss in lung transplant candidates and identify actionable steps to improve transplant bone health management. 

Background / Objective: Lung transplant candidates have high rates of bone loss related to corticosteroids and comorbid factors. This quality improvement project aims to address barriers to guideline-directed therapy and increase pre- and post-transplant GDMT to over 80%. 
Methods: This multidisciplinary QI project will evaluate current practice surrounding bone health management using the Plan-Do-Study-Act (PDSA) framework. QI tools including process mapping, cause-and-effect analysis, and Pareto charting were used to identify gaps in the existing workflow. Baseline data was collected by retrospective chart review for lung transplants performed at UVA Health from January 1 2024 to December 31, 2024 to be compared to post-intervention data. Outcomes of interest included prevalence of osteoporosis and osteopenia, specialist referral and therapy initiation rate, rate of fractures, and follow up bone density scan. Baseline data analysis informed the development of the primary problems list, followed by a multidisciplinary brainstorming of potential solutions. Implementation of the first interventions began in February 2026. New interventions will be introduced monthly, with data analyzed each month to assess impact. 

Results: Baseline analysis identified lower rates of GDMT post-transplant compared with pre-transplant and 18% of patients sustaining a fracture within 1 year. Pareto analysis demonstrated that five drivers accounted for ~80% of care gaps: absence of pre-transplant DEXA, lack of post-transplant DEXA within 1 year, absence of prescriptions for vitamins, lack of pharmacy follow-up, and missing endocrinology visits when indicated. Initial PDSA cycles targeted inappropriate discontinuation of calcium and vitamin D after transplant through pharmacy education and modification of discharge medication reconciliation to ensure continuation of indicated supplements. Interventions are being implemented in two-month cycles with ongoing evaluation.

Conclusion: This QI initiative identified key workflow barriers to guideline-directed bone health management in lung transplant candidates and implemented targeted, multidisciplinary interventions to address them. Ongoing PDSA cycles will evaluate the impact of these and future interventions on screening, treatment, and adverse outcomes rates. This approach may provide a scalable framework for improving bone health optimization in all transplant populations.