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An Outreach Program Improved Osteoporosis Management After a Fracture
Author(s) -
Feldstein Adrianne C.,
Vollmer William M.,
Smith David H.,
Petrik Amanda,
Schneider Jennifer,
Glauber Harry,
Herson Michael
Publication year - 2007
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2007.01310.x
Subject(s) - medicine , osteoporosis , physical therapy , retrospective cohort study , outreach , bone mineral , bone density , femoral neck , cohort , pediatrics , political science , law
This longitudinal retrospective cohort study evaluated implementation of an intervention to improve management of osteoporosis after a fracture in a nonprofit group‐model health maintenance organization (HMO) in the U.S. Pacific Northwest with 480,000 members and electronic medical record data. Participants were female HMO members aged 67 and older who sustained a qualifying clinical fracture(s) and who had not received a bone mineral density (BMD) measurement or osteoporosis treatment in the 12 months before the fracture (N=3,588). Phase 1 included outreach to clinicians and patients; Phase 2 added clinician and staff incentives. Primary outcome was “osteoporosis management”—receipt of a BMD measurement or osteoporosis medication in the 6 months after an index fracture. Before the intervention, 13.4% (95% confidence interval (CI)=12.0–14.8%) of patients had received osteoporosis management, and the time trend was not significant. Postintervention, the probability of osteoporosis management increased on average 3.1% (95% CI=2.6–3.5%) every 2 months throughout both study phases without a significant added improvement in Phase 2. Improvement varied according to clinic and was less likely for patients with dementia. Overall, the probability of osteoporosis management increased from the baseline level of 13.4% to 44.0% (95% CI=40.0–48.0%) by the end of the study period (20 months post‐intervention). The study found that an outreach program to primary care providers and patients improved the management of osteoporosis after a fracture. If widely implemented, this intervention could substantially improve the secondary prevention of osteoporosis. More‐individualized interventions may be necessary for high‐risk subgroups.