Assessment of the clinical management of fragility fractures and implications for the new HEDIS osteoporosis measure.
BACKGROUND
Rates of screening for and treatment of osteoporosis have been low, even among those with fractures who are at greatest risk for new fractures.


OBJECTIVE
The objective of this study was to examine trends in the clinical management of patients with fragility fractures to provide baseline data for future assessments of the impact of the new Health Plan Employer Data and Information Set (HEDIS) measure.


METHODS
The MarketScan Medicare Supplemental and Coordination of Benefits (COB) database was used to examine adherence to the 2004 HEDIS guidelines by measuring the percent of women age 67 and older who were screened and/or treated after a fracture from 2000 through 2005. Clinical, demographic, and provider characteristics were assessed to determine the correlates of being screened and treated.


RESULTS
The overall unadjusted percent of women screened and treated remains low, with just 10.2% screened and 12.9% treated in 2005. Multivariate analyses, which controlled for fracture location, patient characteristics, physician specialty, and region indicated small, albeit statistically significant, increases in treatment and screening over time. Women fracturing in 2005 were 27% more likely to be screened and 15% more likely to receive treatment relative to those fracturing in the year 2000.


CONCLUSIONS
Although our study found some improvements in the screening for and treatment of osteoporosis among Medicare beneficiaries with a fragility fracture from 2000 through 2005, the overall percent of women screened and/or treated remained low. These data provide a baseline for assessing the impact of the new HEDIS measure in the coming years.
Foley
Kathleen A
KA
Thomson Medstat, Washington, DC, USA. Kathleen.foley@thomsom.com
Foster
Shonda A
SA
Meadows
Eric S
ES
Baser
Onur
O
Long
Stacey R
SR
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening; D008499:Medical Records / Q000706:statistics & numerical data*; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D011320:Primary Health Care / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology