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An outreach program improved osteoporosis management after a fracture
Adrianne C Feldstein1, William M Vollmer, David H Smith
1Northwest Permanente, Portland, Oregon, USA. adrianne.c.feldstein@kpchr.org
Journal of the American Geriatrics Society
|October 5, 2007
Summary
An outreach program significantly improved osteoporosis management after fractures in older women. This intervention enhanced secondary prevention by increasing bone density testing and treatment rates.
Area of Science:
- Gerontology
- Public Health
- Health Services Research
Background:
- Osteoporosis management after fracture is crucial for secondary prevention.
- Previous osteoporosis management rates in the studied population were suboptimal.
- Effective interventions are needed to improve post-fracture osteoporosis care.
Purpose of the Study:
- To evaluate an intervention aimed at improving osteoporosis management after fracture.
- To assess the impact of outreach and incentives on clinician and patient engagement.
- To determine the effectiveness of the intervention in increasing bone mineral density (BMD) testing and osteoporosis treatment.
Main Methods:
- Longitudinal retrospective cohort study in a large health maintenance organization (HMO).
- Inclusion of female HMO members aged 67+ with qualifying fractures and no prior BMD or treatment.
- Intervention phases included clinician/patient outreach (Phase 1) and added incentives (Phase 2).
- Primary outcome: osteoporosis management (BMD test or medication) within 6 months post-fracture.
Main Results:
- Baseline osteoporosis management was 13.4%; no significant time trend pre-intervention.
- Post-intervention, management probability increased by 3.1% every 2 months.
- Overall management probability rose to 44.0% by study end (20 months).
- Improvement varied by clinic; less effective in patients with dementia.
Conclusions:
- An outreach program effectively improved osteoporosis management post-fracture.
- The intervention demonstrated substantial potential for secondary osteoporosis prevention.
- Targeted strategies may be needed for high-risk subgroups like patients with dementia.
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