Improving detection and treatment of osteoporosis: redesigning care using the electronic medical record and shared medical appointments.
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.


BACKGROUND
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.
Ayoub
W T
WT
Geisinger Health System, State College and Danville, 200 Scenery Drive, State College, PA, 16803, USA. wayoub@geisinger.edu
Newman
E D
ED
Blosky
M A
MA
Stewart
W F
WF
Wood
G C
GC
D015502:Absorptiometry, Photon; D000359:Aftercare / Q000379:methods*; D000368:Aged; D001071:Appointments and Schedules; D015519:Bone Density; D002118:Calcium / Q000627:therapeutic use; D005194:Family Practice; D005260:Female; D006801:Humans; D016347:Medical Records Systems, Computerized; D015663:Osteoporosis, Postmenopausal / Q000175:diagnosis* / Q000188:drug therapy*; D010044:Outpatient Clinics, Hospital; D012306:Risk; D016896:Treatment Outcome; D014807:Vitamin D / Q000627:therapeutic use
D014807:Vitamin D; D002118:Calcium