UNLABELLED: To determine whether a process redesign could improve detection and treatment of osteoporosis, at-risk women over the age of 65 were identified using an electronic medical record and proactively contacted by letter and phone call. This resulted in a significant increase in testing for osteoporosis by DXA scan. The high-risk patients were then offered a shared medical appointment, which resulted in improved treatment outcomes compared to usual care. INTRODUCTION: Our objective was to determine if redesigning care through proactive contact with women 65 at-risk of osteoporosis increased BMD testing and to determine if a shared medical appointment (SMA) improved treatment for high-risk women. METHODS: Two primary care sites received the redesign intervention and two other sites served as the usual care controls. At the intervention sites, all women 65 who had not had a DXA scan performed in the prior 2 years were contacted by mail and phone calls. High-risk patients were invited to attend a SMA or follow-up visit with their primary physician. RESULTS: A significantly higher proportion of women at the intervention sites had a DXA (39.6% vs. 13.2%, p < 0.0001). Patients who attended the SMA were more likely to have calcium and vitamin D recommended, a vitamin D level checked, and receive a prescription medicine than those patients who had follow-up with their primary care physician. CONCLUSIONS: The redesigned process was highly effective in improving BMD testing for women 65. The SMA was shown to be a more effective method to make calcium and vitamin D recommendations, to evaluate secondary causes of low bone density, and to prescribe prescription medications, compared to usual care with the PCP.
RCT Entities:
UNLABELLED: To determine whether a process redesign could improve detection and treatment of osteoporosis, at-risk women over the age of 65 were identified using an electronic medical record and proactively contacted by letter and phone call. This resulted in a significant increase in testing for osteoporosis by DXA scan. The high-risk patients were then offered a shared medical appointment, which resulted in improved treatment outcomes compared to usual care. INTRODUCTION: Our objective was to determine if redesigning care through proactive contact with women 65 at-risk of osteoporosis increased BMD testing and to determine if a shared medical appointment (SMA) improved treatment for high-risk women. METHODS: Two primary care sites received the redesign intervention and two other sites served as the usual care controls. At the intervention sites, all women 65 who had not had a DXA scan performed in the prior 2 years were contacted by mail and phone calls. High-risk patients were invited to attend a SMA or follow-up visit with their primary physician. RESULTS: A significantly higher proportion of women at the intervention sites had a DXA (39.6% vs. 13.2%, p < 0.0001). Patients who attended the SMA were more likely to have calcium and vitamin D recommended, a vitamin D level checked, and receive a prescription medicine than those patients who had follow-up with their primary care physician. CONCLUSIONS: The redesigned process was highly effective in improving BMD testing for women 65. The SMA was shown to be a more effective method to make calcium and vitamin D recommendations, to evaluate secondary causes of low bone density, and to prescribe prescription medications, compared to usual care with the PCP.
Authors: Stephen F Hodgson; Nelson B Watts; John P Bilezikian; Bart L Clarke; T Kenney Gray; David W Harris; C Conrad Johnston; Michael Kleerekoper; Robert Lindsay; Marjorie M Luckey; Michael R McClung; Howard R Nankin; Steven M Petak; Robert R Recker Journal: Endocr Pract Date: 2003 Nov-Dec Impact factor: 3.443
Authors: D H Solomon; J M Polinski; C Truppo; C Egan; S Jan; M Patel; T W Weiss; Y T Chen; M A Brookhart Journal: Osteoporos Int Date: 2006-07-20 Impact factor: 4.507
Authors: B J Edwards; A D Bunta; J Anderson; A Bobb; A Hahr; K J O'Leary; A Agulnek; L Andruszyn; K A Cameron; M May; N H Kazmers; N Dillon; D W Baker; M V Williams Journal: Osteoporos Int Date: 2012-01-25 Impact factor: 4.507
Authors: L Heyworth; K Kleinman; S Oddleifson; L Bernstein; J Frampton; M Lehrer; K Salvato; T W Weiss; S R Simon; M Connelly Journal: Osteoporos Int Date: 2014-02-25 Impact factor: 4.507
Authors: Amy H Warriner; Ryan C Outman; Adrianne C Feldstein; Douglas W Roblin; Jeroan J Allison; Jeffrey R Curtis; David T Redden; Mary M Rix; Brandi E Robinson; Ana G Rosales; Monika M Safford; Kenneth G Saag Journal: Med Care Date: 2014-08 Impact factor: 2.983
Authors: Amy H Warriner; Ryan C Outman; Elizabeth Kitchin; Lang Chen; Sarah Morgan; Kenneth G Saag; Jeffrey R Curtis Journal: J Bone Miner Res Date: 2012-12 Impact factor: 6.741