title: Development of an electronic medical record based intervention to improve medical care of osteoporosis.
abstract: Osteoporosis is infrequently addressed during hospitalization for osteoporotic fractures. An EMR-based intervention (osteoporosis order set) was developed with physician and patient input. There was a trend toward greater calcium supplementation from July 2008 to April 2009 (s = 0.058); however, use of antiresorptives (13%) or discharge instructions for BMD testing and osteoporosis treatment (10%) remained low.
  
  
  BACKGROUND
  Osteoporosis is infrequently addressed during hospitalization for osteoporotic fractures. The study population consisted of patients over 50 years of age.
  
  
  METHODS
  Northwestern Memorial Hospital is a tertiary care academic hospital in Chicago. This study was conducted from September 1, 2007 through June 30, 2009.
  
  
  RESULTS
  Physicians reported that barriers to care comprised nonacute nature of osteoporosis, belief that osteoporosis should be addressed by the PCP, low awareness of recurrent fractures, and radiographs with terms such as "compression deformity", "wedge deformity", or "vertebral height loss" which in their opinion were not clearly indicative of vertebral fractures. An EMR-based intervention was developed with physician and patient input. Over the evaluation period, 295 fracture cases in individuals over the age of 50 years in the medicine floors were analyzed. Mean age was 72 ± 11 years; 74% were female. Sites of fracture included hip n = 78 (27%), vertebral n = 87 (30%), lower extremity n = 61 (21%), upper extremity n = 43 (15%) and pelvis n = 26 (9%). There was no increase in documentation of osteoporosis in the medical record from pre- to post-EMR implementation (p = 0.89). There was a trend toward greater calcium supplementation from July 2008 to April 2009 (p = 0.058); however, use of antiresorptives (13%) or discharge instructions for BMD testing and osteoporosis treatment (10%) remained low.
  
  
  CONCLUSIONS
  An electronic medical record intervention without electronic reminders created with physician input achieves an increase in calcium supplementation but fails to increase diagnosis or treatment for osteoporosis at the time of hospitalization for a fragility fracture.
authors.affiliation: Bone Health and Osteoporosis Center, Medicine, Feinberg School of Medicine, Northwestern University, 645 North Michigan, Suite 630, Chicago, IL 60611, USA. Bje168@northwestern.edu
authors.forename: B J
authors.initials: BJ
authors.lastname: Edwards
authors.forename: A D
authors.initials: AD
authors.lastname: Bunta
authors.forename: J
authors.initials: J
authors.lastname: Anderson
authors.forename: A
authors.initials: A
authors.lastname: Bobb
authors.forename: A
authors.initials: A
authors.lastname: Hahr
authors.forename: K J
authors.initials: KJ
authors.lastname: O'Leary
authors.forename: A
authors.initials: A
authors.lastname: Agulnek
authors.forename: L
authors.initials: L
authors.lastname: Andruszyn
authors.forename: K A
authors.initials: KA
authors.lastname: Cameron
authors.forename: M
authors.initials: M
authors.lastname: May
authors.forename: N H
authors.initials: NH
authors.lastname: Kazmers
authors.forename: N
authors.initials: N
authors.lastname: Dillon
authors.forename: D W
authors.initials: DW
authors.lastname: Baker
authors.forename: M V
authors.initials: MV
authors.lastname: Williams
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D002118:Calcium / Q000627:therapeutic use; D057286:Electronic Health Records / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization; D006801:Humans; D007087:Illinois; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000517:prevention & control*; D010353:Patient Education as Topic / Q000379:methods; D018802:Patient-Centered Care / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration
chemical_list: D050071:Bone Density Conservation Agents; D002118:Calcium