title: Randomized trial to improve fracture prevention in nursing home residents.
abstract: BACKGROUND
  Interventions to improve the fracture prevention in nursing homes are needed.
  
  
  METHODS
  Cluster-randomized, single-blind, controlled trial of a multi-modal quality improvement intervention. Nursing homes (n=67) with > or =10 residents with a diagnosis of osteoporosis or recent hip fracture (n=606) were randomized to receive an early or delayed intervention consisting of audit and feedback, educational modules, teleconferences, and academic detailing. Medical record abstraction and the Minimum Data Set were used to measure the prescription of osteoporosis therapies before and after the intervention period. Analysis was at the facility-level and Generalized Estimating Equation modeling was used to account for clustering.
  
  
  RESULTS
  No significant improvements were observed in any of the quality indicators. The use of osteoporosis pharmacotherapy or hip protectors improved by 8.0% in the intervention group and 0.6% in the control group, but the difference was not statistically significant (P=.72). Participation in the intervention activities was low, but completion of the educational module (odds ratio [OR] 4.8, 95% confidence interval [CI], 1.9-12.0) and direct physician contact by an academic detailer (OR 4.5, 95% CI, 1.1-18.2) were significantly associated with prescription of osteoporosis pharmacotherapy or hip protectors in multivariable models.
  
  
  CONCLUSIONS
  Audit-feedback and education interventions were ineffective in improving fracture prevention in the nursing home setting, although results may have been tempered by low participation in the intervention activities.
authors: Duke University Center for Aging and Human Development, Durham, NC 27710, USA. colon001@mc.duke.edu
authors: Cathleen S
authors: CS
authors: Colón-Emeric
authors: Kenneth W
authors: KW
authors: Lyles
authors: Paul
authors: P
authors: House
authors: Deborah A
authors: DA
authors: Levine
authors: Anna P
authors: AP
authors: Schenck
authors: Jeroan
authors: J
authors: Allison
authors: Joel
authors: J
authors: Gorospe
authors: Mary
authors: M
authors: Fermazin
authors: Kristi
authors: K
authors: Oliver
authors: Jeffrey R
authors: JR
authors: Curtis
authors: Norman
authors: N
authors: Weissman
authors: Aiyuan
authors: A
authors: Xie
authors: Kenneth G
authors: KG
authors: Saag
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001130:Arizona; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control*; D005598:Fractures, Spontaneous / Q000209:etiology / Q000517:prevention & control; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009657:North Carolina; D009735:Nursing Homes; D016017:Odds Ratio; D010024:Osteoporosis / Q000150:complications / Q000517:prevention & control; D010043:Outcome and Process Assessment, Health Care; D011785:Quality Assurance, Health Care / Q000379:methods*; D016037:Single-Blind Method