title: Minimizing disparities in osteoporosis care of minorities with an electronic medical record care plan.
abstract: BACKGROUND
  Ethnic disparities in care have been documented with a number of musculoskeletal disorders including osteoporosis. We suggest a systems approach for ensuring osteoporosis care can minimize potential ethnic disparities in care.
  
  
  OBJECTIVE
  We evaluated variations in osteoporosis treatment by age, sex, and race/ethnicity by (1) measuring the rates of patients after a fragility fracture who had been evaluated by dual-energy xray absorptiometry and/or in whom antiosteoporosis treatment had been initiated and (2) determining the rates of osteoporosis treatment in patients who subsequently had a hip fracture.
  
  
  METHODS
  We implemented an integrated osteoporosis prevention program in a large health plan. Continuous screening of electronic medical records identified patients who met the criteria for screening for osteoporosis, were diagnosed with osteoporosis, or sustained a fragility fracture. At-risk patients were referred to care managers and providers to complete practice guidelines to close care gaps. Race/ethnicity was self-reported. Treatment rates after fragility fracture or osteoporosis treatment failures with later hip fracture were calculated. Data for the years 2008 to 2009 were stratified by age, sex, and race/ethnicity.
  
  
  RESULTS
  Women (92.1%) were treated more often than men (75.2%) after index fragility fracture. The treatment rate after fragility fracture was similar among race/ethnic groups in either sex (women 87.4%-93.4% and men 69.3%-76.7%). Osteoporotic treatment before hip fracture was more likely in white men and women and Hispanic men than other race/ethnic and gender groups.
  
  
  CONCLUSIONS
  Racial variation in osteoporosis care after fragility fracture in race/ethnic groups in this healthcare system was low when using the electronic medical record identifying care gaps, with continued reminders to osteoporosis disease management care managers and providers until those care gaps were closed.
authors.affiliation: Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Kaiser Permanente, South Bay Medical Center, 25825 South Vermont Avenue, Harbor City, CA 90710, USA. Ronald.A.Navarro@kp.org
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Navarro
authors.forename: Denise F
authors.initials: DF
authors.lastname: Greene
authors.forename: Raoul
authors.initials: R
authors.lastname: Burchette
authors.forename: Tadashi
authors.initials: T
authors.lastname: Funahashi
authors.forename: Richard
authors.initials: R
authors.lastname: Dell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D019033:Delivery of Health Care, Integrated; D057286:Electronic Health Records; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D008913:Minority Groups; D054525:Minority Health / Q000208:ethnology*; D010024:Osteoporosis / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000378:metabolism; D011287:Prejudice; D011859:Radiography; D012737:Sex Factors