Provider characteristics: impact on bone density utilization at a health maintenance organization

Information from bone mineral density (BMD) is relevant in guiding postmenopausal osteoporosis prevention and treatment, yet many providers do not typically order BMDs. This study was designed to identify physician characteristics associated with utilization of bone densitometry in a northeastern US health maintenance organization (HMO).

Internal medicine primary providers in practice at a northeastern HMO between April 1997 and March 1998 were categorized by BMD utilization, based on the number of BMDs performed during that time per number of women older than 50 years in their patient panel. In one analysis, providers in the highest quintile for this parameter were considered "high utilizers" (n = 25), and those in the lowest quintile, "low utilizers." These groups were compared with respect to provider characteristics and practice composition. In a second analysis, multiple variable linear regression was used to predict the likelihood of utilization of BMD as a function of those parameters for all providers.

The range of BMDs by provider was 0 to 190 per 1,000 women >50 years (median = 34) over this 1-year period. Providers who were high utilizers had a significantly greater number of female patients more than age 50 in their practice (p < 0.05) and were also more likely themselves to be female (62% vs. 48%; p < 0.05). There was no association between BMD utilization and age of provider or years in practice. Female provider gender (p < 0.01) and greater percentage of women more than age 50 in the practice (p < 0.05) were independent predictors of BMD utilization in a multivariate model.

BMDs were infrequently utilized by the majority of providers over this 1-year period. Female provider gender was associated with a significantly greater likelihood of BMD utilization that was not simply explained by the greater number of women in these providers' practices. These findings may be relevant to identifying strategies to improve bone health care in this population.